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RESULT

The results were obtained by direct measurement using Doppler


Ultrasonography 4 weeks and 6 weeks after surgery in patients with chronic
renal failure stage 5 which operated arteriovenous fistula during the month
of August 2015 - December 2015. Total patients who underwent Doppler
ultrasound mapping as many as 58 patients. A total of 23 patients were
excluded before surgery with details: 16 patients did not meet the inclusion
criteria, 4 patients are not willing to be a subject of study, 3 patients with
inoperable because of shortness of breath. During the study has been
conducted arteriovenous fistula surgery in 35 patients, 2 patients were
excluded because died after surgery, 3 patients can not control regularly
during the study and 3 patients had failed to mature. Patients who have
failed to mature arteriovenous fistula operation has been carried over, 1
patient died after reoperation arteriovenous fistula, 2 patients were excluded
from the sample for reasons of research time. The total sample size in this
study of 27 patients. Radiocephalica fistula surgery as many as 15 patients
and performed brachiocephalica fistula surgery as many as 12 patients.
The data is processed by using SPSS 23. The data were analyzed
descriptively and seeking relationships maturation of 4 weeks and 6 weeks
postoperatively wearing McNemar test with a confidence level of 95%. P
value <0.05 was considered statistically significant.
Sample characteristic
Table. 1.Distribusi frekuensi karakteristik sampel
Variabel
Gender
Male
Female
Age Group
< 45 tahun
45 60 tahun
> 60 tahun
Type of Operation
Radiocephalica Fistula
Brachiocephalica Fistula
Etiology
DM Type II
Hypertension
Glomerulonephritis
Nefrolithiasis
Comorbid

21
6

77,8
22,2

5
15
7

18,5
55,6
25,9

15
12

55,6
44,4

12
9
5
1

44,5
33,3
18,5
3,7

Description

Mean: 54,37
SD 10,393

Hyperlipidemia
Hypertensi
Obesity
Stroke
Smokers
Congestive heart failure
Unknown

2
8
2
1
3
7
4

7,4
29,6
7,4
3,7
11,1
25,9
14,9

In Table patients with chronic renal failure stage 5 arteriovenous fistula


surgery performed more -Eighteen male gender (77.8%). Radiocephalica
fistula surgery is mostly done in 15 patients (55.6%). The largest age group
of 45-60 years (55.6%) with an average of 54.37 10.393 years. Etiology
Most is Type 2 diabetes mellitus (44.5%), while the highest is comorbid
hypertension (29.6%).

Table.2.Doppler ultrasound characteristics of the sample results


Standard
Mean

Deviation

Median Minimum Maximum

2,57

0,51

2,3

2,1

3,8

3,1

0,86

2,85

2,2

2,47

0,33

2,5

3,1

4,11

0,504

4,15

3,2

1,98

0,586

3,2

1,9

0,561

1,75

1,1

4,987

0,847

4,9

6,9

3,6

cephalica vein diameter pre-op


(mm)

Radiocephalica fistula

Brachiocephalica fistula

Diameter of the artery feeding


artery pre-op (mm)

Radiocephalica fistula

Brachiocephalica fistula

Distance vein cephalica skin into


pre-op (mm)

Radiocephalica fistula

Brachiocephalica fistula

4 weeks ndraining vein diameter


(mm)

Radiocephalica fistula

Brachiocephalica fistula

6,58

1,12

6,55

4,8

8,7

395,947

229,98

341,2

98,4

890

804,83

484,36

685,5

146

1894

2,34

0,73

2,4

1,3

4,2

2,9

1,07

2,7

1,3

4,6

5,55

0,81

5,5

3,8

7,2

7,66

1,27

7,75

5,4

10,4

547,3

270,06

593,2

145,6

1067

1162,1

471,46

1111,5

518,4

1972

1,92

0,523

1,1

2,4

0,866

2,2

1,3

4,1

Volume 4 weeks vein draining


flowdf0(ml/mnt)

Radiocephalica fistula

Brachiocephalica fistula

Jarak draining vein ke kulit 4


minggu (mm)

Radiocephalica fistula

Brachiocephalica fistula

Diameter draining vein 6 minggu


(mm)

Radiocephalica fistula

Brachiocephalica fistula

Volume Flow draining vein 6


minggu (ml/menit)

Radiocephalica fistula

Brachiocephalica fistula

Jarak draining vein ke kulit 6


minggu (mm)

Radiocephalica fistula

Brachiocephalica fistula

Based on table 2, the results of patients who underwent Doppler


ultrasound radiocephalica fistula surgery there is an increase in the average
value cephalica vein diameter of 2.57 0.51 mm preoperatively, be 4.987
0.847 mm 4 weeks postoperatively and 5.55 0, 81 mm 6 weeks
postoperatively. There is an increase in the average value of the diameter of
the vein cephalica patients brachiocephalica fistula surgery of 3.1 0.86

mm before surgery, to be 6.58 1.12 mm 4 weeks postoperatively and 7.66


1.27 mm post surgery 6 weeks.
The average value of the radial artery diameter of 2.47 0.33 mm,
while the average value of brachial artery diameter of 4.11 0.504 mm.
There is an increase in the average value of the distance vein
cephalica to the skin in patients who do fistula surgery radiocephalica of 1.98
0.586 mm preoperatively, to 2.34 0.73 mm 4-week post-operative surgery, but
suffered a shortening of the average value cephalica venous distance to the skin to
1.92 0.523 mm 6 weeks postoperatively. There is an increase in the average
value of the distance vein cephalica to the skin in patients brachiocephalica fistula
surgery of 1.9 0.561 mm preoperatively, to 2.9 1.07 mm 4 weeks post surgery,
but suffered a shortening of the average value of the distance cephalica venous skin
to be 2.4 0.866 mm.
There is an increase in the average value radiocephalica fistula flow
volume of 395.947 229.98 ml / min 4 weeks postoperatively, be 547.3 270.06
ml / min 6 weeks postoperatively. Increased volume flow occurs also in
brachiocephalica fistula from 804.83 484.36 ml / min 4 weeks postoperatively, be
1162.1 471.46 ml / min 6 weeks postoperatively.

Evaluation of postoperative radiocephalic fistula maturation by time


Table .3. Radiocephalica relationship postoperative fistula maturation by time
Operation type

Maturation
4 weeks

6 weeks Maturation Result


Matur
Not Matur

Total

p
McNemar

Fistula
Radiocephalica

Matur

f
1

%
100

f
0

%
0

f
1

%
100

Not Matur
Total

1
2

7,1
13,4

13
13

92,9
86,6

14
15

100
100

1,00

Based on Table . radiocephalic obtained fistula mature patients at


week 4 by 6.7%, while the mature patients at week 6 by 13.3%. This difference was
not statistically significant (p> 0.05), ie there is no correlation radiocephalica
postoperative fistula maturation by time.

Evaluation of postoperative brachiocephalic fistula maturation by time


Table .4. Post-operative relationship brachiocephalic fistula maturation by time
Operation Types

Brachiocephalica
Fistula

Maturatio
n
4 weeks
Matur
Not
Matur
Total

6 weeks Maturation Results


Matur
Not Matur

Total

p
McNemar

f
6

%
100

f
0

%
0

f
6

%
100

83,3

16,7

100

11

91,7

8,3

12

100

0,063

Based on the table .4. brachiocephalic fistula patients found that mature at week 4
by 50%, whereas patients who mature at week 6 by 91.7%. This difference was not
statistically significant (p> 0.05), ie there is no correlation radiocephalica
postoperative fistula maturation by time.