Angiologia e Cirurgia Vascular (Mar 2011)
Consulta de acessos vasculares para hemodiálise: experiência de um centro Outpatient clinic for vascular access in hemodialysis patients: A single-centre experience
Abstract
Introdução: Os acessos vasculares são responsáveis por elevada morbilidade nos doentes em hemodiálise. A fístula arteriovenosa (FAV) representa o acesso vascular com menor taxa de complicações, pelo que a Consulta de Acessos Vasculares para hemodiálise procura promover o aumento da sua taxa de patência. Métodos: avaliação retrospectiva dos motivos de referenciação à consulta entre 01-01-2008 e 31-12-2009, do resultado das intervenções e análise dos factores relacionados com a patência da FAV. Resultados: Avaliaram-se 697 doentes (58% homens, 30% diabéticos, idade média 64±15 anos) referenciados para construção de acesso (71%), suspeita de estenose (14%), síndrome de roubo (6%) pseudoaneurismas (4%) e hipertensão venosa (HTV) (3%). Os acessos construídos foram FAV simples (n=514; 91% dos doentes), transposição da veia basílica (n=40) e pontagem arteriovenosa com prótese (n=10). A taxa de patência global (às 4 semanas) foi 83% (75%, 93% e 40% respectivamente nas FAVs, transposições e pontagens). A localização proximal da FAV (p Background: The vascular access is responsible for high morbidity in for hemodialysis patients. Arteriovenous fistula (AVF) provides the vascular access with lower complication rate, so the Consulta de Acessos Vasculares for hemodialysis promotes actions to increase its patency rate. Methods: Retrospective study of the causes for referral to consultation between 01/01/2008 and 31/12/2009, outcome of proposed interventions and factors favoring AVF patency. Results: We evaluated 697 patients (58% male, 30% diabetic, mean age 64 ± 15 years) referred for construction of access (71%), suspicion of stenosis (14%), steal syndrome (6%), pseudoaneurysm (4%) and venous hypertension (HTV) (3%). The constructed access were simple AVF (n=514, 91% of patients, transposition of the basilic vein (n=40) and prothesic arteriovenous graft (n=10). The global access patency rate (at 4th week) was 83% (with 75%, 93%, 40% for AVFs, transposition and grafts, respectively). Proximal location of AVF (p <0.01) and preoperative Doppler evaluation (p = 0.02) were associated with better outcomes. AVF venous stenosis was treated with angioplasty, endovascular (45%) and surgical (23%), with patency rates of 95% and 90%, respectively. The steal syndrome was treated by AVF reduction with banding in 57% of cases (84% success) and AVF ligation in 16%. Endovascular angioplasty was preformed in 57% of cases of HTV (success of 84%). Aneurysmectomy was performed in 50% of patients with pseudoaneurysms with preservation of AVF patency in 90% of cases. Conclusion: Interventions outcomes were similar to those of international studies. Preoperative evaluation by Doppler ultrasound improved the AVF patency.
