Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang: Stenosis vena sentral adalah salah satu permasalahan utama yang dihadapi dalam penggunaan akses hemodialisis FAV. Kondisi ini dapat ditangani dengan tindakan single balloon angioplasty. Namun, tatalaksana ini memiliki angka patensi yang tidak memuaskan akibat respon pembuluh darah terhadap barotrauma. Mengetahui risiko yang mempengaruhi patensi pasca tindakan single baloon angioplasty pada penderita stenosis vena sentral penting untuk memprediksi prognosis pasien. Penelitian ini bertujuan untuk mengetahui faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Metode: Sebuah penelitian kohort retrospektif multicenter pada Januari 2018 – September 2022 di empat rumah sakit dilakukan untuk menilai faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Faktor yang diteliti mencakup derajat stenosis, panjang stenosis, jumlah stenosis, lokasi stenosis, residual stenosis, ukuran balon, dan tekanan balon. Hasil: Terdapat total 76 pasien pada penelitian ini. Pada penelitian ditemukan faktor yang berpengaruh pada patensi 6 bulan pasca single balloon angioplasty adalah jenis kelamin laki – laki (78.4% vs 46.2%; p 0.004), panjang stenosis ≥ 2 cm (85.7% vs 56.5%; p 0.042), lokasi stenosis pada vena innominata (75% vs 39.3%; p: 0.002),derajat stenosis ≥ 80% (83.3% vs 42.5%; p : 0.001), dan residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). Tidak ditemukan faktor yang berpengaruh pada patensi 12 bulan pasca single balloon angioplasty. Kesimpulan: Terdapat hubungan antara panjang stenosis, lokasi stenosis, derajat stenosis, dan residual stenosis terhadap patensi single balloon angioplasty ......Background: Central venous stenosis is one of the main problems encountered in AVF hemodialysis access. This condition can be treated with a single balloon angioplasty. However, this treatment has a low patency rates due to the response of the vessels to barotrauma. Knowing the risks that affect patency after single balloon angioplasty in patients with central venous stenosis is important to predict the patient's prognosis. This study aims to determine the factors influencing 6 and 12 months patency after single balloon angioplasty in central venous stenosis patient. Methods: A multicenter retrospective cohort study in January 2018 – September 2022 in four hospitals was conducted to assess factors that affect 6 and 12 months patency after single balloon angioplasty in patients with central venous stenosis. Factors studied included the degree of stenosis, length of stenosis, number of stenosis, location of stenosis, residual stenosis, balloon size, and balloon pressure. Results: There were a total of 76 patients in this study. In this study, it was found that the factors that affected the patency 6 months after single balloon angioplasty were male gender (78.4% vs 46.2%; p 0.004), stenosis length ≥ 2 cm (85.7% vs 56.5%; p 0.042),stenosis at the innominate vein (75% vs 39.3%; p: 0.002), stenosis degree ≥ 80% (83.3% vs 42.5%; p : 0.001), and residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). There were no factors that had an effect on patency 12 months after single balloon angioplasty. Conclusion: There is a relationship between the length of the stenosis, the location of the stenosis, the degree of stenosis, and the residual stenosis on the patency of single balloon angioplasty

Abstrak :
Latar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.Kata kunci: stenosis vena sentral, kateter hemodialisis temporer, akses vaskular ......Background The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter

Abstrak :
Stenosis atau oklusi vena sentral merupakan komplikasi serius pada pasien hemodialisis yang secara signifikan menurunkan kwalitas hemodialisis yang efektif patensi semua komponen akses vascular dialisis, termasuk arteri beserta cabangnya, AV anastomosis, vena perifer, dan vena sentral, sangat penting untuk penyediaan dialisis yang konsisten, kuat, nyaman, dan tidak rumit. Etiologi utama  stenosis vena sentral (SVS) sebagian besar adalah sekunder akibat penempatan kateter dialisis yang sementara ataupun menetap pada vena subclavia, vena  jugular internal, dan vena femoralis. Terapi endovascular standar stenosis vena sentral adalah angioplasty dengan balon konvensional. Analisis deskriptif dilakukan untuk menilai karakteristik serta sebaran data masing-masing variabel yang kemudian disajikan dalam bentuk tabuler atau grafik. Data kategorik disajikan dalam bentuk persentase dan dilakukan uji statistik dengan Chi-square atauFisher (univariat dan bivariat). Data yang akan dibandingkan adalah keberhasilan setelah tindakan Endo Vaskular dibandingkan antara riwayat pemasangan kateter vena sentral di vena subclavia dan vena jugularis interna, dengan tipe kateter, onset gejala, dan durasi pemasangan kateter sebagai variabel perancu. Dari hasil analisis data di temukan faktor-faktor bermakna yang berhubungan dengan keberhasilan tindakan Endo Vaskular pada pasien stenosis vena sentraldengan POBA (p>0.005) adalah ; onset gejalaklinis (<3 bulan), durasipemasangankateter (<2,5 bulan), riwayat pemasangan kateter sebelumnya (baru 1 kali), Initial stenosis (kurangdari 80), serta diameter POBA (> 10 mm). Diperlukan SOP untuk pemasangan KVS yang sesuai standar KADOQi untuk mengurangi resiko kejadian SVS. Diperlukan strategi screening yg lebih baik untuk mendeteksi  kasusSVS. Perlu edukasi kepada tenaga medis dan pasien mengenai durasi pemasangan KDL akut. Mengoptimalkan akses vaskuler permanen AVF sebagai Akses vaskular idaman penderita GGK yg menjalani HD.Perlu perhatian yang lebih dari pemerintah atau pihak penjamin kesehatan, karena keterbatasan biaya yang membuat tindakan Endo Vaskuler pada kasus SVS menjadi kurang optimal, terutama pada kasus re-Intervensi dan inisial stenosis yg berat (>80%).

---

Central venous stenosis or occlusion is a serious complication in hemodialysis patients that significantly decreases effective hemodialysis quality The patency of all components of dialysis vascular access, including arteries and branches, AV anastomosis, peripheral veins and central veins, is essential for the provision of consistent, adequate dialysis, comfortable, and not complicated. The main etiologies of central venous stenosis (SVS) are mostly secondary to temporary or persistent dialysis / chemoteraphycatheter placement in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy of central venous stenosis is angioplasty with conventional balloons. Descriptive analysis is done to assess the characteristics and distribution of data for each variable which is then presented in tabular or graphical form. Categorical data is presented in the form of a percentage and statistical tests are performed by Chi-square or Fisheries (univariate and bivariate). Data to be compared is the success after endovascular action compared between the history of central venous catheter placement in the subclavian vein and internal jugular vein, with, catheter type, symptom onset, and duration of catheter placement as confounding variables. The results of data analysis found significant factors related to the success of endovascular action in patients with central venous stenosis with POBA (p> 0.005) are; onset of clinical symptoms (<3 months), duration of catheter placement (<2.5 months), history of catheter placement (only 1 time), initial stenosis (less than 80), and diameter of POBA (> 10 mm). According with KADOQi standards is needed to reduce the risk of SVS events. A better screening strategy is needed to detect SVS cases. Need education to medical staff and patients regarding the duration of the installation of acute KDL. Optimizing AVF permanent vascular access as ideal vascular access for people with CRF who undergo HD. More attention is needed from the government or health guarantor, because of the limited costs that make endovascular actions in SVS cases less optimal, especially in cases of re-intervention and severe initial stenosis (> 80%).