No abstract

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The radiocephalic arteriovenous fistula (avf) at the wrist is the first choice for hemodialysis access. Several authors have reported diabetes mellitus (DM) as an independent risk factor on primary failure and patency of the fistula, also reports stating that DM is only a clinically comorbid factor. We aimed to investigate the effect of DM on primary failure and patency rates of distal radiocephalic avf. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 87 patients (43 diabetic and 44 non diabetic) who underwent distal radiocephalic avf operations between May 2011-January 2013 were reviewed retrospectively. Demographic findings and data about radial artery and cephalic vein were documented. Primary failure and 6 months primary patency of the fistula were also calculated retrospectively. R Re es su ul lt ts s: : The mean cephalic vein diameters were similar but the mean radial artery diameter (2.34±0.26 mm versus 2.63±0.38 mm, p=0.0002) and the mean radial artery flow (25.05±11.8 ml/min versus 28.9±11.3 ml/min. p=0.0277) of the diabetic group were significantly lower. There were no significant differences on primary failure and primary patency rate for 6 months. C Co on nc cl lu us si io on n: : Even though the mean radial artery diameter and flow were lower in diabetic group, there are no significant differences at primary failure and patency rates. By so we conclude that DM is not an independent risk factor on primary failure or patency rate of the fistula but may be a comorbid factor. Radiocephalic arteriovenous fistula at the wrist remains our first choice for both diabetic and non-diabetic patients.K Ke ey y W Wo or rd ds s: : Diabetes complications; arteriovenous fistula; kidney failure, chronic Ö ÖZ ZE ET T A Am ma aç ç: : Kronik böbrek yetmezlikli hastalarda hemodiyaliz tedavisinin el bileği seviyesinde oluşturulan radiosefalik arteriovenöz fistül (avf) ile yapılması ilk tercih edilen yöntemdir. Bazı otör-ler Diabetes Mellitus (DM) hastalığını, fistülün açıklık süresinde ve olgunlaşma başarısızlığı konusunda net olarak olumsuz bir risk faktörü olarak tanımlasa da bazıları bu durumu sadece klinik bir komorbidite olarak tanımlamaktadır. Biz de bu çalışmamızda bu çelişkili durumu aydınlatmayı planladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Hastanemizde Mayıs 2011-Ocak 2013 tarihleri arasında el bileği seviyesinden avf ameliyatı olan 87 hastanın (43 diyabetik ve 44 diyabetik olmayan) demografik verileri ile radial arter ve cephalic ven ile ilgili verileri geriye doğru tarandı. Fistül olgunlaşmasında başarısızlık durumu ile 6 aylık açıklık süreleri incelendi. B Bu ul lg gu ul la ar r: : Ortalama sefalik ven çapları arasında fark yok iken, ortalama radial arter çapı (2,34±0,26 mm ve 2,63±0,38 mm, p=0,0002) ve ortalama radial arter akımı (25,05±11,8 ml/dak ve 28,9±11,3 ml/dak, p=0,0277) diyabetik grupta diyabetik olmayan gruba göre anlamlı oranda düşük tespit edildi. Fistül olgunlaşmasında başarısızlık ve 6 aylık açıklık oranları...

Abstract OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl’s eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl’s eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl’s eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl’s eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate–severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl’s eye reconstruction was the only factor independently related to moderate–severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl’s eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.