Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease

Introduction: Matured native arteriovenous fistula (AVF) is an optimal vascular access for supporting the haemodialysis blood circuit. Maturation of AVF involved complex vascular remodeling including shunting of blood flow from arterial system toward the low resistance venous limb. In this study...

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Main Author:	Cheng, Chai Siew
Format:	Thesis
Language:	English
Published:	2017
Subjects:	RC870-923 Diseases of the genitourinary system Urology
Online Access:	http://eprints.usm.my/44847/1/Dr.%20Chai%20Siew%20Cheng-24%20pages.pdf
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spelling	my-usm-ep.448472020-10-22T03:03:13Z Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease 2017 Cheng, Chai Siew RC870-923 Diseases of the genitourinary system. Urology Introduction: Matured native arteriovenous fistula (AVF) is an optimal vascular access for supporting the haemodialysis blood circuit. Maturation of AVF involved complex vascular remodeling including shunting of blood flow from arterial system toward the low resistance venous limb. In this study, we would like to evaluate the change of skin microvascular perfusion over the extremity with AVF maturation by using laser doppler flowmetry. Method: Total of 45 consented patients with chronic kidney disease (CKD) Stage IV-V who underwent AVF creation over upper extremity from July 2014 to Jun 2016 at Hospital Universiti Sains Malaysia were included in this study. The measurement of skin microvascular perfusion was done with laser doppler flowmetry pre-operative and post operative day 1, week 2, week 6 and week 12. Assessment of AVF maturation was done by 6 weeks. Result: Thirty-two patients with mean age of 55.6 (20 male, 12 female) had achieved AVF maturation. There were 13 (40.6%) radial-based and 19 (59.4%) brachial-based AVF. There was 32.8% reduction of mean skin perfusion distal to the fistula by day 1 compare to baseline perfusion but perfusion increased back by 47% by Week 2 compare to day 1 and no dramatic change upon AVF maturation. At the area proximal to anastomosis AVF, there was increasement of mean skin perfusion over 12 weeks with 35.8% at day 1 from baseline. However, the change of mean skin perfusion was not statistically significant. There was also no significant relation of skin perfusion change with the type of fistula, diabetes mellitus, hypertension and hyperlipidemia. Conclusion: Laser doppler flowmetry successfully detected the subclinical change of skin microvascular perfusion relation with AVF creation and maturation. Reduction of skin perfusion distal to the fistula suggested that in patients with existing perfusion inadequacy of extremities may experiences ischemic symptom as early as day 1 post operation and need close monitoring for distal limb ischemic-related complications. 2017 Thesis http://eprints.usm.my/44847/ http://eprints.usm.my/44847/1/Dr.%20Chai%20Siew%20Cheng-24%20pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan,
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RC870-923 Diseases of the genitourinary system Urology
spellingShingle	RC870-923 Diseases of the genitourinary system Urology Cheng, Chai Siew Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
description	Introduction: Matured native arteriovenous fistula (AVF) is an optimal vascular access for supporting the haemodialysis blood circuit. Maturation of AVF involved complex vascular remodeling including shunting of blood flow from arterial system toward the low resistance venous limb. In this study, we would like to evaluate the change of skin microvascular perfusion over the extremity with AVF maturation by using laser doppler flowmetry. Method: Total of 45 consented patients with chronic kidney disease (CKD) Stage IV-V who underwent AVF creation over upper extremity from July 2014 to Jun 2016 at Hospital Universiti Sains Malaysia were included in this study. The measurement of skin microvascular perfusion was done with laser doppler flowmetry pre-operative and post operative day 1, week 2, week 6 and week 12. Assessment of AVF maturation was done by 6 weeks. Result: Thirty-two patients with mean age of 55.6 (20 male, 12 female) had achieved AVF maturation. There were 13 (40.6%) radial-based and 19 (59.4%) brachial-based AVF. There was 32.8% reduction of mean skin perfusion distal to the fistula by day 1 compare to baseline perfusion but perfusion increased back by 47% by Week 2 compare to day 1 and no dramatic change upon AVF maturation. At the area proximal to anastomosis AVF, there was increasement of mean skin perfusion over 12 weeks with 35.8% at day 1 from baseline. However, the change of mean skin perfusion was not statistically significant. There was also no significant relation of skin perfusion change with the type of fistula, diabetes mellitus, hypertension and hyperlipidemia. Conclusion: Laser doppler flowmetry successfully detected the subclinical change of skin microvascular perfusion relation with AVF creation and maturation. Reduction of skin perfusion distal to the fistula suggested that in patients with existing perfusion inadequacy of extremities may experiences ischemic symptom as early as day 1 post operation and need close monitoring for distal limb ischemic-related complications.
format	Thesis
qualification_level	Master's degree
author	Cheng, Chai Siew
author_facet	Cheng, Chai Siew
author_sort	Cheng, Chai Siew
title	Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
title_short	Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
title_full	Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
title_fullStr	Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
title_full_unstemmed	Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
title_sort	skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan,
publishDate	2017
url	http://eprints.usm.my/44847/1/Dr.%20Chai%20Siew%20Cheng-24%20pages.pdf
_version_	1747821411687202816

Skin microvascular perfusion change with arteriovenous fistula creation in chronic kidney disease

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