Incidência de estenoses hemodinamicamente significativas em diversos tipos de acessos para hemodiálise- estudo prospectivo

Abstract

Introduction: Renal failure has a high prevalence worldwide and the main form of treatment is hemodialysis[1]. The evidence currently recommends the arteriovenous fistula (AVF) as the first choice of access for hemodialysis[2] Fistulas have higher patency and lower complication rates compared to prostheses and catheters[3]. However, complications can occur, stenosis being the main one, increasing morbidity and mortality. The possible association between the surgical modality and the occurrence of stenosis may provide an important prognostic parameter. Objectives: To evaluate the incidence of hemodynamically significant stenosis in several types of surgery for making a VAF. Methodology: This was a prospective observational study of patients who underwent hemodialysis arteriovenous fistula procedures at the Hospital das Clínicas, UFMG. The patients were evaluated using vascular Doppler ultrasound at pre-defined intervals: immediate post-op, 1st PO day (post-op day), 7th PO day, 30th PO day and then every 30 days until the 210th day. Results: Thirty-one patients were selected and submitted to brachial plexus block for AVF creation. Among the AVFs performed, 22.5% used the brachiobasilic technique, with superficialization of the basilic vein. In the others, several techniques were used, such as brachiocephalic, radiocephalic, among others. Among the brachiobasilic techniques, the cumulative stenosis rate was 71.4%. Among the other modality used, the rate was 25% with a p-value of 0.0239. This finding is consistent with that found in the literature. Ergene et al. (2020), presented in their study that 63.6% of the stenoses found occurred in the basilic vein superficialization technique.[4] Conclusion: Brachiobasilic arteriovenous fistulas with basilic vein superficialization have a higher incidence of hemodynamically significant stenoses when compared to other surgical modalities.