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"Pendahuluan. Penelitian ini merupakan penelitian lanjutan untuk melakukan pengkajian nilai batasan bloodflow rate BFR intraoperatif menggunakan ultrasonografi Doppler dalam memprediksi maturitas fistula brakiosefalika dengan sampel yang lebih besar dan lebih spesifik untuk mendapatkan nilai dengan tingkat error dan bias lebih rendah, sehingga nantinya dapat dijadikan referensi di divisi Bedah Vaskular RSCM. Metode. Dilakukan studi potong lintang analitik di Divisi Vaskular Departemen Ilmu Bedah FKUI-RSCM, Jakarta yang melibatkan semua penderita gagal ginjal stadium 4-5 akibat nefropati diabetik yang akan dihemodialisis dengan akses vaskular fistula brakiosefalika. Hasil. Terdapat 71 subjek dengan rerata BFR 249,15 86,86 mL/menit, rerata diameter arteri 3,3 mm 2,0-7,4 mm dan rerata diameter vena 3 mm 2,1-5,6 mm. Analisis statistik menunjukkan bahwa hanya BFR yang berhubungan bermakna dengan maturitas AVF p80.

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Introduction. This research is a follow-up study to determine the value limits of bloodflow rate BFR intraoperative using Doppler ultrasound to predict maturity of brachiocephalic fistula with a larger sample and to obtain lower level of error and bias, so it can be used as a reference in the Vascular Surgery division, Cipto Mangunkusumo Hospital.

Methods. Cross-sectional design with analytic fashion conducted at Division of Vascular Surgery Department of the Faculty of medicine - Cipto Mangunkusumo Hospital, Jakarta with all patients with stage IV-V CKD, due to diabetic nephropathy who planned to get vascular access for hemodialysis brachiocephalic fistula.

Result. Total subject are 71 with mean bloodflow rate is 249.15 86.86 mL / min, mean arterial diameter is 3.3 mm 2.0 to 7.4 mm and the mean diameter of the vein is 3 mm 2.1 to 5.6 mm . Only BFR associated significantly with maturity AVF p

BFR intraoperatif, maturitas AV fistula, brakiosefalika, sensitivitas, spesifisitas"

"Dewasa ini akses vaskular hemodialisis dan segala permasalahannya masih menjadi penyebab perawatan di rumah sakit dan morbiditas pada pasien gagal ginjal kronik. Dibalik keutamaan dan superioritas penggunaan fistula arteriovenous (AVF) sebagai akses vaskular hemodialisis, kegagalan maturasi merupakan hambatan utama penggunaannya. Penelitian ini bertujuan mengkaji dapatkah bloodflow rate (BFR) yang diukur intraoperatif menggunakan ultrasonografi Doppler memprediksi maturasi AVF. Metode penelitian adalah potong lintang. Hasil didapatkan BFR intraoperatif menggunakan ultrasonografi Doppler sesaat setelah kreasi AVF brakiosefalika dapat memprediksi maturasi dengan nilai titik potong sebesar 245,5 mL/menit, didapatkan nilai sensitifitas sebesar 76,7% , spesifisitas 92,9%, nilai duga positif 95,8% dan nilai duga negatif 65% sehingga dapat menjadi acuan menentukan perlu tidaknya tindakan revisi saat intraoperatif yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi AVF.

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Currently, vaskular access for haemodialysis and its assocoiated problems is the leading cause for hospital admission and morbidity in patients with chronic kidney failure. Arteriovenous fistula (AVF) is the preferred vaskular access for haemodialysis, however its use is impeded by issues of maturation. This cross sectional study aims to evaluate whether bloodflow rate (BFR), measured intraoperatively using Doppler ultrasonography, can predict AVF maturation. The result from this study showed that intraoperative BFR measured using Doppler ultrasonography right after the creation of the brachiocephalic fistula can predict the fistula’s maturation. The intraoperative BFR cut-off value was 245,5 mL/min, with sensititivity of 76,7%, specificity 92,9%, positive predictive value of 95,8% and negative predictive value 65%. Therefore, the intraoperative BFR may be used as a guide to decide whether or not a corrective procedure was needed to repair the brachiocephalic AVF, and consequently, help in reducing the rate of AVF maturation failure.

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"Latar belakang: Fistula arteriovenous (FA V) merupakan akses terbaik untuk melakukan hemodialisis. Kegagalan maturasi fistula arteriovenous merupakan hambatan utama penggunaannya. Penelitian ini bertujuan menilai dapatkah bloodjlow rateyang diukur intraoperatif menggunakan ultrasonografi Doppler dapat menjadi prediktor maturitas F A V radiosefalika. Subjek dan Metode: Subjek adalah pasien-pasien yang akan dibuat F A V radiosefalika dengan usa mapping sesuai standar. Sesaat setelah anastonosis diukur bloodjlow ratedengan usa Doppler probe linear. Penelitian ini menggunakan desain potong lintanganalitik untuk mendapatkan hubungan maturasi FA V dengan bloodjlow rateintraoperatif.Hasil:FA V radiosefalika (n=71) pada 71 pasien dibuat dan dievaluasi dalam 6 minggu. Reratabloodjlow rateintraoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (201,85 dan 141,96 mllmenit; P 165,5 ml/menit memiliki nilai prediktor yang baik untuk maturasi FA V radiosefalika,sehingga dapat menjadi acuan menentukan perlu tidaknya penilaian lebih lanjut dan tindakan revisi saat intraoperatif, yang pada akhimya diharapkan dapat menurunkan angka kegagalan maturasi fistula arteriovenous.

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Background: Arteriovenous fistula (A VF) is the best access to hemodialysis. The failure of arteriovenous fistula maturation is a major obstacle to its use. This study aims to assess whether an intraoperative bloodflow rate measured with Doppler ultrasound can be a predictor of the maturity ofradiocephalicA VF.Subjects and Methods: Subjects were patients to be made radiocephalic A VF with USG mapping according to the standard. Shortly after anastonosis bloodflow rate was measured with a linear probeDoppler ultrasound. This study used cross sectional analytic design to obtain radiocephalic A VF maturation relationship with intraoperative blood flow rate. Results: Radiocephalic A VF(n = 71) in 71 patients were made and evaluated in 6 weeks. The mean intraoperative blood flow rate in mature fistulas was significantly higher than those not mature (201.85 and 141.96 mLimin; P <0.001). Bloodflow rate with a cut-off value of 165.5 mLimin has a sensitivity of 93.8%, specificity 95.7%, positve predictive value 97.8% and negative predictive value 88.5%.Conclusion: Bloodflow rate> 165.5 mLimin has a good predictor value for radiocephalic A VF maturation, so it can be a reference to detem1inewhether the need for further assessment and revision action intraoperatively, which in tum is expected to decrease the maturation failure rate of arteriovenous fistula."

"Latar belakang. Timbulnya stasis darah dan pembesaran atrium kiri menyebabkan peningkatan angka kejadian trombus di atrium kiri dan apendiks atrium kiri (Left Atrial Appendage-LAA) pada SM. Diameter atrium kiri yang membesar disebutkan sebagai faktor terjadinya pembentukan LASEC dan meningkatkan angka kejadian tromboemboli. Selain itu adanya stasis darah yang dibuktikan dengan penurunan ejeksi fraksi LAA dan kecepatan aliran darah LAA dapat mencetuskan timbulnya trombus. Perubahan moluker adhesi sICAM-1 dan sVCAM-1 berhubungan dengan kejadian tromboemboli. Tetapi apakah terdapat hubungan antara peran hemodinamik, terutama terhadap diameter, fraksi ejeksi dan kecepatan aliran darah pada LAA dengan kadar molekul adhesi seperti sICAM-1 dan sVCAM-1 belum terjawab. Metode. Pasien SM derajat sedang-berat (tanpa adanya regurgitasi mitral signifikan) yang menjalani pemeriksan ekokardiografi transesofageal diikutsertakan secara konsekutif sejak Januari-April 2014. Penilaian fungsi apendiks atrium kiri dilakukan dengan pemeriksaan transesofageal ekokardiografi. Kadar sICAM-1 dan sVCAM-1 dari vena perifer diukur dengan teknik enzyme-linked immunosorbent assay. Hasil. Sebanyak 26 subyek penelitian dengan rerata usia 38,92±11,93 tahun, 65,3% berjenis kelamin perempuan, dan 46,1% memiliki irama fibrilasi atrium. Dengan sampel tersebut, didapatkan tidak ada hubungan antara komponen fungsi apendiks atrium kiri, baik diameter, ejeksi fraksi, dan kecepatan aliran darah LAA dengan kadar sICAM-1. Tidak terdapat hubungan antara fungsi LAA pada variabel diameter dengan kadar sVCAM-1. Terdapat hubungan terbalik antara ejeksi fraksi LAA dengan kadar sVCAM-1 (-0,21, p=0.038, 95%KI -0,41- -0,01) dan hubungan terbalik antara kecepatan aliran darah LAA dengan kadar sVCAM-1 (-0,29, p=0,048, 95%KI -0,59- -0,003). Kesimpulan. Semakin rendah ejeksi fraksi dan kecepatan aliran darah LAA maka semakin tinggi kadar sVCAM-1.

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Background: Blood stasis and left atrial enlargement increase the incidence of thrombus in the left atrium and left atrial appendage (LAA). Enlargement of left atrial diameter is a factor for LASEC formation and increase the incidence of thromboembolism. Blood stasis which evidenced by a decrease in ejection fraction and LAA blood flow velocity can trigger the presence of thrombus. Changes in soluble adhesion molecules sICAM-1 and sVCAM-1 associated with thromboembolic events. But relationship between the role of hemodynamics, especially the ejection fraction and blood flow velocity in the LAA with the levels of adhesion molecules such as sICAM-1 and sVCAM-1 is not well understood.

Methods: Patient with moderate-severe Mitral Stenosis (in the absence of significant mitral regurgitation) underwent transesophageal echocardiography from January to April 2014. Levels of sICAM-1 and sVCAM-1 from peripheral vein were measured by enzyme-linked immunosorbent technique assay.

Results: A total of 26 subjects with a mean age of 38.92 ± 11.93 years, 65.3% female, and 46.1% had atrial fibrillation. We found no association between components of left atrial appendage function: diameter, ejection fraction and blood flow velocity of LAA with sICAM-1 levels. There was no relationship between the LAA function in the variable diameter of LAA with sVCAM-1 levels. There is an inverse relationship between ejection fraction of LAA and levels of sVCAM-1 (-0.21, p = 0.038, 95% KI -0,41- -0,01) and an inverse association between LAA blood flow velocity and levels of sVCAM-1 (-0 , 29, p = 0.048, 95% KI -0.59 - 0.003).

Conclusion: Low ejection fraction of LAA is associated with higher the levels of sVCAM-1. Low LAA blood flow velocity is associated with higher the levels of sVCAM-1."

"Ièlth dilakukan suatu penelitian "Cross sectional study" pada para akseptor yang telah rnenggunakan kontrasepsinya antara 1 - 4 tahun dibandingkan dengan wanita yang baru akan menggunakan p11. Ada 3 golongan subyek penelitian, .yaitu akseptor KB yang telah menggunakan p11 oral kombinasiberisi mestranol 0,05 mg dan noretindron 1 mg secara terusrnenerus, akseptor KB yang telah menggunakan AKDPL tipe Lippes Loop secara terus menerus dan wanita yang baru akan menggunakan pil dan minimal 3 bulan sebéluinnya tidak menggunakan alat kontrase p si apaun. Masing-masing golongan terdiri darf 30 orang, berusia 20 - 35 tahun.Penentun kadar, kolesterol total den-an metode Siedel dkk. Kolesterol-HDL ditentukan dengan metode Burstein dkk.Trigliserida ditentukan dengan metode Wahlefeld dkk. Sedangkan kolesterol-LDL ditentukan secara tidak langsung dengan menggunakan rumus Friedewald; kesemuanya dilakukan denganmenggunakan Kits Boehringer Mannheim.Dengan uji statistik Anova satu arah dan tes "q", didapatkan hal-hal berikut Kadar rata-rata kolesterol total. dan kolesterol-LDL pada akseptor p11 oral lebih tinggl bermakna dari wanita yang tidak menggunakan alat kontrasepsi (p < 0,05). Sedangkanpada akseptor p11 oral lebih tinggi dari AKDR, tetapi perbedaannya tidak berrnakna pada "level significance" 5%.Kadar rata-rata trigliserida pada akseptor pil oral lebih tinggi bermakna dan. akseptor AKDR dan wanita yang tidak menggunakan alat kontrasepsi ( p < O ,05). Kadar rata-rata klesterol total, kolesterol-LDL dan tnigliserida pada akseptorAKDR leblh tinggi dari wanita yang tidak menggunakan alat kontrase p si, tetapi perbedaannya tidak bermakna pada "level significance" 5%. Tidak terdapat perbedaan bermakna dari kadar rata-rata kolestero1-HDL dan berat badan antara akseptorp11 oral, AKDR dan wanita yang tidak menggunakan alat kontrasepsi. Usia rata-rata akseptor p11 oral dan AKDRlebib tinggi bermakna dari wanita yang tidak menggunakan alatkontrasepsi (P-< 0,05), sedangkan akseptor AKDR lebih tinggi dari p11 oral, tetapi perbedaannya tidak bermakna pada "level significance" 5%.Wanita yang tidak menggunakan alat kontrasepsi tidak mempunyaikeluhan apapun, sedangkan akseptor AKDR mempunyailebih banyak keluhan subyektif yang menyangkut adanya faktor mekanis dalam saluran reproduksi daripada akseptor pil oral.

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A cros sectional study was done on acceptors who -

have been using their contraception between 1 - LI years.It

was compared with women who will have used of the pill. -

There were 3 groups of subject acceptors who have been -

using combination oral contraceptives (0,05 mg mestranol +

I mg noretindrone ) continuously, acce ptors who have been -

using Intrauterine Device (IUD) continuously, and women who

will have used of the pill and they were not using contraception

(minimum 3 months before treatment).

P1 thod of Siedel et al. was used to measure the to -

tal Cholesterol levels; and Burstein et al. to measure the

HDL-Cholesterol; and ahlefeld et al. to measure the Tn -

glyceride. Indirect method of Fniedewald was used to estimate

the LDL-Cholesterol. The Boehringer MannheimKits were

used for this purposes.

By using the "One way analysis of variance" and test

"q", it was found that

The man levels of total Cholesterol and LDL-Choles

terol in oral pill acceptors were significantly higher -

than nonusers (p < 0 ,05). Oral pill acceptors were higherthan

IUDs, but not significant ( p > 0 , 0 5) . The mean level -

of Tniglyceride in oral pill acceptors was significantly -

higher than IUDs and nonusers (P< 0,05). The mean levels of total Cholesterol, LDL-Cholesterol and Triglyceride in-

IUD acceptors were higher than nonusers, but not signifi -

cant (P> 0 ,05). There were significant different of the -

mean level of HDL-Cholesterol and body weight between oral

pill, IUD acceptors and nonusers. The mean ages of oral -

pill and IUD acceptors were significantly higher than nonu

sers (p < 0,05). IUD acceptors was higher than oral pill,-

but not siificant (P> 0,05).

No corrlaint was found for nonusers; and IUD accep -

tors had more subjective complaint than oral gills in rela

tion with mechanic factor in the reproductive tube."

"ABSTRAK Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakanpenyebab utama perawatan di rumah sakit. Kegagalan maturitas merupakan hambatan utamapenggunaan arteriovenous fistula. Tujuan dari penelitian ini adalah untuk mengkaji korelasi peaksistolik velocity arteri brakialis dan volume flow draining vein intraoperatif denganmenggunakan ultrasonografi doppler untuk memprediksi maturasi AVF. Uji statistik yangdigunakan adalah uji Mann Whitney dan uji Chi Squere. Hasil yang didapatkan tidak ditemukankorelasi antara PSV arteri brakialis dengan maturitas. Rerata nilai titik potong volume flowdraining vein intraoperatif 259,43 ml/min dan paska operatif 679,22 ± 65,36 ml/mindihubungkan dengan maturitas, ini dapat menjadi acuan menetukan perlu tidaknya melakukantindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angkakegagalan maturasi AVF. ABSTRACT Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure."

"Latar Belakang : Hemodialisis merupakan terapi pengganti ginjal yang paling banyak digunakan di dunia. Fistula Arteriovenosa (FAV) merupakan pilihan akses vaskular terbaik bagi penderita Penyakit Ginjal Tahap Akhir (PGTA) yang menjalani hemodialisis. Akan tetapi, kegagalan maturasi FAV masihrelatif tinggi akibat gangguan dari înflow dan/atau outflow. Pengukuran peningkatan Blood Flow Rate (BFR) dan Peak Systolic Velocity (PSV) intraoperasi pada arteri brakialis diharapkan dapat mengidentifikasi masalah inflow sekaligus outflow sebagai penyebab kegagalan maturasi FAV.Tujuan : Mengetahui hubungan peningkatan BFR dan PSV arteri brakialis intraoperasi serta nilai batasannya yang dapat dijadikan prediktor maturasi FAV Brakiosefalika.Subjek dan Metode : PGTA yang menjalani operasi FAV brakiosefalika di lima Rumah Sakit (RSCM, RSUP Fatmawati, RSUD Kab. Tangerang, RS Hermina Depok dan RS Hermina Bekasi) pada periode Juli 2019 – Februari 2022. Desain penelitian kohort retrospektif menggunakan data sekunder dari penelitian sebelumnya Data yang diteliti meliputi: usia, jenis kelamin, tekanan darah, merokok, diabetes melitus, dan hasil pengukuran USG doppler berupa diameter arteri brakialis dan vena sefalika preoperasi serta peningkatan BFR dan PSV arteri brakialis intraoperasi, kemudian data subjek dengan FAV brakiosefalika yang mengalami maturasi dalam 6 minggu sesuai kriteria rule of 6 dari NKF-KDOQI. Selanjutnya dilakukan analisa statistik adanya korelasi peningkatan BFR dan PSV arteri brakialis intraoperasi terhadap maturitas FAV brakiosefalika serta ditetapkannya nilai batasan sebagai prediktor maturasi. dengan memakai uji diagnostik grafik Receiver Operator Curve (ROC). Hasil : Dari total 83 subjek yang memenuhi kriteria inklusi dan eksklusi, terdapat 50 (60,24%) subjek yang mengalami maturasi dalam 6 minggu pascaoperasi. Dengan menggunakan analisis multivariat dengan uji regresi logistik, peningkatan BFR arteri brakialis intraoperasi (p<0,001) merupakan faktor yang paling berhubungan dengan maturasi FAV brakiosefalika setelah 6 minggu pascaoperasi dengan nilai batasan 184,58 ml/menit, sensitivitas 100%, spesifisitas 84,8%, Nilai Duga Positif 90,9%, Nilai Duga Negatif 100%, Akurasi 93,98%Kesimpulan : Peningkatan BFR arteri brakialis intraoperasi dapat dipakai sebagai prediktor maturasi FAV brakiosefalika 6 minggu pascaoperasi

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Background : Hemodialysis is the most widely used renal replacement therapy in the world. Arteriovenous fistula (AVF) is the best vascular access option for patients with End Stage Kidney Disease (ESKD) undergoing hemodialysis. However, the AVF maturation failure rate is still high due to inflow and/or outflow problem. Measurement of intraoperative increase in Blood Flow Rate (BFR) and Peak Systolic Velocity (PSV) in the brachial artery is expected to identify inflow and outflow problems as the cause of AVF maturation failure.

Objective: To determine the relationship between intraoperative increase in BFR and PSV of the brachial artery and the cut off point that can be used as a predictor of Brachiocephalic AVF maturation.

Subjects and Methods : ESKD who underwent AVF brachiocephalic surgery in five hospitals (RSCM, Fatmawati Hospital, Tangerang Hospital, Hermina Hospital Depok and Hermina Hospital Bekasi) in the period July 2019 – February 2022. The retrospective cohort study design used secondary data from the study previously. The data studied included: age, sex, blood pressure, smoking, diabetes mellitus, and the results of Doppler ultrasound measurements of preoperative brachial artery and cephalic vein diameters and an increase in intraoperative BFR and PSV brachial artery, then data on subjects with maturation of brachiocephalic AVF within 6 weeks according to the rule of 6 criteria of the NKF-KDOQI. Furthermore, statistical analysis was carried out on the correlation between increased intraoperative brachial artery BFR and PSV on brachiocephalic FAV maturity and the determination of cut off value as a predictor of maturation using the Receiver Operator Curve (ROC) graphic diagnostic test.

Results: From a total of 83 subjects who met the inclusion and exclusion criteria, there were 50 (60.24%) subjects who matured within 6 weeks postoperatively. Using multivariate analysis with logistic regression, the increase in intraoperative brachial artery BFR (p<0.001) was the most associated factor of brachiocephalic FAV maturation after 6 weeks postoperatively with a cut off value of 184.58 ml/min, sensitivity 100%, specificity 84.8%, Positive Predictive Value 90.9%, Negative Predictive Value 100%, Accuracy 93.98%

Conclusion: Increased intraoperative brachial artery BFR can be used as a predictor of brachiocephalic FAV maturation 6 weeks postoperatively."

"Intervensi Koroner Perkutan Primer (IKPP) merupakan pilihan utama untuk mengembalikan aliran darah dan perfusi pasien yang mengalami Infark Miokard Akut dengan Elevasi Segmen ST (IMA-EST). Tapi tidak selalu mengembalikan aliran yang cukup pada tingkat mikrosirkulasi, hal ini disebabkan oleh obstruksi mikrovaskular (OMV). Banyak penelitian telah membuktikan pengaruh inflamasi terhadap kejadian OMV, tingginya rasio neutrofil limfosit pasca IKPP menggambarkan respon inflamasi. Tujuan penelitian ini adalah untuk menilai hubungan rasio neutrofil limfosit (RNL) terhadap kejadian obstruksi mikrovaskular yang dinilai dengan pemeriksaan myocardial blush kuantitatif (QuBE). Metode: Sebanyak 33 subjek IMA–EST yang menjalani IKPP dipilih secara konsekutif sejak 1 September 2013 sampai 30 Oktober 2013. RNL diambil saat masuk UGD, penilaian myocardial blush (MB) diambil segera pasca IKPP, angiografi untuk RCA (RAO 30˚) dan LCA (LAO 60˚-90˚). Kemudian RNL dikirim ke laboratorium untuk diperiksa dengan dengan Sysmex 2000i, blush dinilai dengan program komputer QuBE. Perhitungan statistik dinilai dengan SPSS 17. Hasil: Dari 33 pasien didapatkan proporsi terbanyak berjenis kelamin laki-laki sebesar 75,7%, rerata usia pasien 56±9.8 tahun. Analisa statistik menunjukkan tidak terdapat hubungan antara RNL dan QuBE (β=-0,180;p=0,664) namun terdapat kecenderungan setiap kenaikan 1 unit RNL akan menurunkan QuBE sebesar 0,180 unit arbiter. Setelah dilakukan adjusted terhadap faktor perancu didapatkan kecenderungan penurunan yang lebih besar meskipun tetap tidak menunjukkan hubungan yang bermakna. (koef β=-0,331 ; p=0,527).

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Primary percutaneus coronary intervention (PPCI) is a first of choice to return patient’s blood flow and perfusion with ST elevation myocardial infarction (STEMI). However, it is not always sufficiently reflow of microcirculation due to Microvascular Obstruction (MVO). Many studies had proved that neutrophil to lymphocyte ratio (NLR) has emerged as a potent composite inflammatory marker. The aim of this study is to evaluate association between NLR and MVO by Quantitative Blush Evaluator (QuBE).

Methode: 33 STEMI patients undergoing primary PCI were consecutivly recruited from September to October 2013. The NLR was withdraw at patient admission. We evaluate the myocardial blush immediately after PCI done. Angiography views were RAO 30˚ for RCA, and LAO 60˚-90˚for LCA. Then the NLR was sent to laboratory for examination. QuBE was done to evaluate myocardial blush. Statistical analysis was done by SPSS 17.

Results: From thirty three patients included in the study, there were 75,75% men, with mean age 56±9.8 years old. Statistical analysis showed no correlation between NLR and QuBE (β=-0,180;p=0,664) but there was decrease of 0,180 unit arbiter QuBE for each 1 unit of peripheral NLR. After adjustment of confounding factor, there was more decreasing value although there is no significant correlation. (coef β=-0,331;p=0,527)."

"Tujuan: Pemeriksaan ultrasonography doppler pra operasi pada arteri dan vena sudah menjadi standar untuk membantu pembuatan fistula arteriovena (FAV) sebagai akses hemodialisis, tetapi pengukuran indeks rasio arteriovenous (RAV) yang diperoleh dari  diameter arteri dibagi dengan diameter vena hanya dengan ultrasonography biasa serta penerapannya melalui hukum Bernoulli belum banyak diteliti. Penelitian ini berusaha  mengetahui hubungan antara variabel rasio diameter arteri dan vena dengan prediktif pematangan FAV.

Metode: Sebuah studi kohort prospektif pada 144 pasien yang menjalani FAV dalam periode 6 bulan. Variabel demografi, komorbiditas dan indeks RAV dinilai melalui analisis regresi logistik bivariat pada evaluasi akhir kematangan. RAV dibuat tiga titik desimal untuk mendapatkan akurasi maksimal pada sensitivitas terbaik dan spesifisitas pada kurva karakteristik. Uji probabilitas (nilai P) dianggap signifikan dengan P <0,05. Hasil dilaporkan sebagai odds-rasio dengan interval kepercayaan 95%.

Hasil: Didapatkan maturitas FAV pada 92 (63,89%) dari 144 pasien (P = 0,05; Interval kepercayaan 95%; 59,8%-78,6%). Pada Index RAV 0,93 - 1,14 didapatkan 86,90% FAV yang matur (P <0,001) sedangkan lebih sempit lagi pada Index RAV 1,01 - 1,06 didapatkan 100% FAV yang matur (P <0,002). Penurunan atau kenaikan indeks ini berhubungan dengan penurunan tingkat maturitas.  

Kesimpulan: Teknik pengukuran ini (indeks RAV) sebagai prediktor maturitas dalam FAV disarankan untuk diteliti lebih lanjut. Studi ini menyiratkan bahwa rasio diameter antara arteri dan vena berhubungan maturitas, terlepas dari variabel lain tetap berpengaruh pada faktor mekanik dan biologis terhadap hemodinamik yang optimal (tekanan dan kecepatan) pada pematangan FAV

 

 

Kata kunci: Fistula Arterivenous, Indeks Rasio Arterivenous, Pematangan fungsional.

Objective: Preoperative doppler ultrasonography  examination has become a standard to assist in making arteriovenous fistulas (AVF) as access to hemodialysis, but measurements of arteriovenous ratio index (AVR) obtained from arterial diameter and venous diameter and its application through Bernoulli's law have not been widely studied. This study to determine the relationship between the variable ratio of blood vessel diameter and predictive maturation of AVF.

Method: A prospective cohort study with a view to recording 144 patients underwent AVF in period of 6 months. Demographic, comorbid and RAV index variables were assessed through bivariate logistic regression analysis at the final evaluation of maturity. AVR is made of three decimal points in order to obtain maximum accuracy for the best sensitivity and specificity on the characteristic curve. The probability test (P value) is considered significant with P <0.05. Results are reported as odds ratios with 95% confidence intervals.

Results: AVF maturity was obtained in 92 (63.89%) of 144 patients (P = 0.05; 95% confidence interval; 59.8%-78.6%). In the AVR Index 0,93-1,14 obtained 86,90% mature AVF (P <0.001) and more sharp AVR Index 1.01 to 1.06 obtained 100% mature AVF (P <0.002). This decrease or increase in index is related to a decrease in the level of maturity.

Conclusion: This measurement technique (AVR index) as a predictor of AVF maturity is strongly suggested for further investigation. This study implies that the minimum ratio of diameter between arteries and veins relates to maturity rate, regardless of other variables that still have an important influence on mechanical and biological factors with optimal hemodynamics (pressure and speed) in AVF maturation

 

 

 

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