Autori: Battaglia Yuri1, Malvicini Enzo2, Stano Rocco3, Gianesini Sergio4, Vasquez Giorgio3, Antonio Granata5, Michele Prencipe6, Occhionorelli Savino2
Affiliazioni: 1 Department of Specialized Medicine, Division of Nephrology and Dialysis, Hospital-University St. Anna, Ferrara (Italy) 2 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara 3 Department of Surgery, Emergency Surgery Service, Hospital-University St. Anna, Ferrara 4 Vascular Disease Center, University of Ferrara 5 Nephrology and Dialysis Unit, San Giovanni di Dio Hospital, Agrigento 6 Nephrology and Dialysis Unit, “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo.
Objective: The native radio-cephalic arteriovenous fistula(AVFs)still remains the gold standard of vascular access for patients on chronic hemodialysis. The aim of the study was to assess the AVFs maturation comparing absorbable sutures and non-absorbable ones in native vessels.
Methods:Surgeries performed during a period of 24 months by a single expert surgeon were evaluated. Surgeries that met the inclusion criteria, namely age ≥ 18 years and radio-cephalic AVFs for hemodialysis treatment were considered.
According to the type of suture, patients were classified as: Max-group(absorbable suture)and Prol-group(non-absorbable).Clinical characteristics(age, gender, ESRD etiology, cigarette smoking, etc),comorbidity(Diabete Mellitus, Hypertension, etc),drugs(anticoagulants, thrombolytics, and anti-platelets agents), complications AVF(thrombosis, infections etc), duplex ultrasound parameters pre and post-operative were collected.
Results:
Data pertaining to 101 out of 70 patients were collected; 51% were men and the mean age was 73 (SD = 11.9).In the Max-group an increasing blood flow was observed during the first four weeks without postoperative complications.In Prol-group, 6 patients had thrombosis that resulted in vascular access failure.At the 1st week the duplex doppler ultrasound of both groups showed a regular AVFs maturation, with an increase of blood flow rate.
Although pre-operative post-tourniquet vein diameters(0,237±0,068)of the Max-group were not adequate, the vein diameter and the blood flow rate increased of 0.121 mm(p<0.0001)and 1.123 mL/min(p<0.0001)at four weeks, respectively. On the contrary, in the Prol-group the vein diameters decreased from 0.5369 mm at 1 week to 0.4685 mm at 4 weeks and blood flow rate reduced from 1.304 L/min at 1 week to 1.011 L/min at 4 weeks(p ˂ .0001).
Conclusions:The maturation of AVFs and its functional performance might not only depend on the characteristics of the native vessels and on surgeon’s technical skills but also on the type of suture(absorbable/non-absorbable).Absorbable sutures were correlated with better AVFs maturation and primary patency rate compared to non-absorbable ones.