الفهرس 
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Abstract
Chronic kidney disease (CKD) has become an emerging public health problem and a major economic and social burden. The prevalence is estimated to be as high as 11%–13% in the general population. Internationally, CKD was responsible for 1.2 million deaths and 35 million disability-adjusted life-years (DALYs) in 2016.
Hemodialysis is the most preferable modality for end stage renal disease (ESRD), a suitable long-lasting vascular access (VA) is crucial for their treatment, VA flow dysfunction is one of the most important causes of morbidity, and mortality with increased healthcare costs among HD patients, Therefore, the aim of the current study is to report VA patency outcomes after intervention for flow dysfunction detected by regular duplex ultrasonography (DUS) surveillance associated with the presence of clinical indicator(s).
We conducted prospective, non-randomized, observational study that included 170 Patients discovered to have vascular access dysfunction.
The mean age of this study population was 48.9 ± 12.1 years ranging from 19 years to 73 years with, 59.4% of them were males and 40.6% were females. Diabetes mellitus was found in 47.1% of the study patients. 40% of the study population were e hypertensives.
As regards the access characteristics Brachiocephalic and basilic vein transpositions AVFs were predominant in 44.1%, and 27.6% respectively, while AVGs were reported in 13.5% (23/170). The mean access age was 13.9 months ± 8.3 SD with median 10.
Different clinical presentations were recorded; the majority was arm swelling (32.9%), difficult cannulation (27%), and decreased thrill, Prolonged bleeding from puncture site occurred in 7.1% of the patients, and 10.6% had dilated chest collaterals/neck veins.
Underlying single lesion was detected in most patients (77.1%, 131/170) while (22.9%,39/170) had multiple lesions and the majority were juxta-anastomotic (42.9%, 73/170), and at the proximal swing point (22.9%, 39/170), while central vein lesion was detected in 17 cases. Most of lesions were stenotic in nature (86.5%),while 13.5% of the lesion were occlusions. The total lesion length was categorized into <2 cm 25 (14.7%), 2-5 cm 104 (61.2%), >5 cm 41 (24.1%).
Balloon angioplasty ± stenting was used in (82.9%, 141/170), and (17.1%, 29/170) had surgical Patch angioplasty. Our study postoperative technical success was (100%, 170/170). Early thrombosis (1st postoperative day) was found in 5 patients and were abandoned.
The 30 day, 90 day, 6 month, and 12 month primary patencies were (85.3 ± 2.7 %), (75.4 ± 3.3%), (58.3 ± 4.0 %), respectively. Assisted primary patency was reported at 3, 6, 12 months and was 92.4 ± 2.0 %, 86.8 ± 2.6 %, and 78.0 ± 3.3 % respectively.
Univariate analysis for predictors of loss of primary patency is reported in table 3. Multivariate analysis using Cox proportional-hazards regression model revealed that, decreased access age (HR 0.93; 95% CI, (0.89-0.97); p 0.0014), presence of occlusive lesions (HR, 1.96; 95% CI, (1.10-3.48); p 0.02), and total lesion length >5cm (HR, 2.47; 95% CI, (1.38-4.43); p 0.0026) were the only significant independent predictors of loss of primary patency.
They were Thirty patients were censored due to loss of follow up (n= 15), death (n=8.), and renal transplantation (n=7). Also, around twenty five VAs were complicated by either thrombosis (n=13), infection (n=7), and pseudo-aneurysm (n= 5).
Conclusion:
This study highlights the role of monitoring and surveillance to stay ahead of the anticipated progressive access dysfunction and to intervene in a timely manner so that under-dialysis and access clotting do not occur. It has to be a part of an integrated and efficient team work between the patient’s dialysis providers and the vascular surgeons.