Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study

Abstract

Teguh Marfen Djajakusumah, Putie Hapsari, Prapanca Nugraha, Arrayyan Muhammad, Kiki Lukman Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Kiki Lukman; Teguh Marfen Djajakusumah, Email [email protected]; [email protected]: End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications.Materials and Methods: This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record.Results: Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010).Conclusion: Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.Plain Language Summary: Chronic kidney failure is a particular challenge in terms of health problems in Indonesia. With the increase in kidney failure patients, the number of dialysis patients in this country has also sharply increased because blood dialysis is the main management for end-stage kidney failure. Dialysis treatment does not mean it is 100% safe; various complications can arise from the blood dialysis procedure. Many of the complications that arise are caused by problems with the blood vessels that serve as access to the dialysis machine. In this research, we aim to study the characteristics of blood dialysis complications related to blood vessel access. This study was conducted at one of the largest national hospitals in Indonesia, precisely in West Java province, which is the most populated province in Indonesia. In this study, we involved 121 end-stage kidney failure patients. This study is very important to carry out considering that around 30% of chronic kidney failure patients that were hospitalized have complications from blood vessels. We hope that this research can be used further in determining the best procedure for providing venous access for dialysis with all the limitations faced by developing countries.Keywords: arteriovenous fistula, end-stage kidney disease, hemodialysis, pseudoaneurysm, vascular access

Keywords

• arteriovenous fistula
• end-stage kidney disease
• hemodialysis
• pseudoaneurysm
• vascular access.