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"Pendahuluan: Iskemia tungkai kritis (ITK) merupakan penyakit vaskular yang memiliki risiko mortalitas dan amputasi yang tinggi. Insidens dari penyakit arteri perifer (PAP) khususnya ITK di Amerika mencapai 500-1000 kasus per 1 juta orang setiap tahunnya. Intervensi endovaskular (EVI) merupakan salah satu metode terapi ITK yang menjadi pilihan utama karena secara signifikan menurunkan risiko amputasi dan meningkatkan limb salvage. Penatalaksanaan menggunakan EVI terbagi menjadi balloon angioplasty dan stent angioplasty. Penelitian ini bertujuan untuk mengetahui efektivitas dari metode EVI dalam pemyembuhan luka akibat ITK.Metode: Dilakukan studi cross sectional dengan 90 subjek ITK yang menjalani intervensi endovaskular berupa balloon angioplasty dan stent angioplasty di Rumah Sakit dr. Cipto Mangunkusumo dari Januari 2013 hingga Juli 2017. Lama penyembuhan luka diantara kedua metode dianalisis menggunakan uji T tidak berpasangan dengan nilai p<0,05 dianggap bermakna secara statistik. Data yang diambil berupa metode EVI, lama penyembuhan luka, dan data karakteristik subjek (usia, riwayat amputasi, IMT, riwayat merokok, DM, lokasi pembuluh darah, dan profil darah).Hasil: Persebaran data lama perawatan pada kelompok balloon angioplasty dan stent angioplasty menunjukan hasil yang normal dengan rerata 84,8 ± 2,423 hari dan 59,93 ± 2,423 hari dengan perbedaan rerata 25 hari. Perbedaan rerata antara kedua faktor bermakna secara statistik (p<0,05). Kejadian amputasi pada kelompok balloon angioplasty dan stent angioplasty adalah 22 dan 16 kejadian dengan perbedaan yang tidak bermakna secara statistik (p<0,05).Kesimpulan: Metode stent angioplasty lebih baik dibandingkan metode balloon angioplasty dalam hal lama penyembuhan luka pada pasien ITK.

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Introduction: Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus, the most significant risk factor in CLI, is very common among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is non invasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI.

Method: A cross sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty and stent angioplasty from January 2013 to July 2017 in dr. Cipto Mangunkusumo General Hospital, Jakarta. The wound healing period between balloon angioplasty and stent angioplasty were analyzed using unpaired T-test with p<0,05 considered as statistically significant. Data of intervention method, wound healing period, and subjects characteristic data (age, amputation, BMI, smoking habit, DM, occlusion site, and blood profile) were obtained.

Result: The wound healing period in balloon angioplasty and stent angioplasty distributed normally. Mean value of wound healing period in balloon angioplasty and stent angioplasty is 84,8 ± 2,423 and 59,93 ± 2,423 days with mean difference of 25 days. The difference of wound healing period in both group is statically significant (p<0,05). The amputation event in balloon angioplasty and stent angioplasty is 22 and 16 event with no difference statistically.

Conclusion: Stent angioplasty is better method than balloon angioplasty for wound healing in patients with CLI."

"Latar belakang: Pada iskemia tungkai kritis (ITK) infrapoplitea, tatalaksana utama bertujuan untuk revaskularisasi. Salah satu teknik revaskularisasi ITK infrapoplitea adalah plain old balloon angioplasty. Namun, masih terdapat re-stenosis yang terjadi setelah prosedur tersebut. Oleh karena itu, perlu dilakukan penelitian mengenai luaran prosedur disertai faktor-faktor yang mempengaruhinya. Metode: Penelitian ini merupakan penelitian kohort retrospektif, dengan populasi seluruh pasien ITK infrapoplitea yang menjalani tatalaksana revaskularisasi plain old balloon angioplasty di RSUPN Dr. Cipto Mangunkusumo dari Januari 2013-Mei 2017. Faktor inklusi yaitu subjek dengan PAP Rutherford derajat ≥ 4 dan kontrol minimal 1 kali pasca prosedur. Pengambilan data dilakukan melalui rekam medis dan registrasi pasien divisi bedah vaskular Departemen Ilmu Bedah RSUPN Dr. Cipto Mangunkusumo. Luaran yang dinilai adalah kejadian re-stenosis, amputasi, dan penyembuhan luka 1 tahun pasca-tindakan. Faktor yang diteliti pada penelitian ini adalah demografi, indeks massa tubuh (IMT),ankle-Brachial Index (ABI) komorbiditas, dan derajat Rutherford. Hasil: Terdapat 28 pasien subjek dalam penelitian ini. Kejadian re-stenosis terjadi pada 53,6% subjek. Kejadian amputasi terjadi pada 50% subjek. Luka semakin memburuk ditemukan pada 46,4% subjek. Terdapat hubungan antara perburukan luka pasca tindakan dengan derajat Rutherford subjek (p = 0,030). Terdapat hubungan antara riwayat penyakit jantung koroner (PJK) dengan perbaikan luka pasca tindakan (p = 0,014). Tidak didapatkan hubungan faktor lain dengan luaran ITK infrapoplitea yang menjalani plain old balloon angioplasty. Kesimpulan: Luaran ITK infrapoplitea yang menjalani plain old balloon angioplasty belum baik dilihat dari tingginya luaran re-stenosis, amputasi, dan penyembuhan luka. Derajat Rutherford sebelum tindakan berhubungan dengan luaran penyembuhan luka pasca tindakan.

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Background: In infrapopliteal critical limb ischemia (CLI), the treatment aimed to re-vascularized the vessel. One of infrapopliteal CLI re-vascularization technique is plain old balloon angioplasty. However, there were re-stenosis reported after that procedure. A study to evaluate the procedure outcome and the factors affecting it.

Methods: The design of this study is retrospective cohort, with population include all infrapopliteal CLI patients underwent plain old balloon angioplasty re-vascularization in Cipto Mangunkusumo General Hospital from Janury 2013-May 2017. Subjects with Rutherford category ≥ 4 and return to hospital to control minimal 1 time after procedure. Data acquired through medical record and Vascular Surgery Division registry. Outcome evaluated including re-stenosis, amputation, and wound healing 1-year post-procedure. Factors analysed in this study were demography, body mass index (BMI), ankle-brachial index (ABI), comorbidity, and rutherford category.

Results: There were 28 patients acquired in this study. Re-stenosis occurred in 53.6% subjects. Amputation occurred in 50% subjects. Wound worsen in 46.4% subjects. There were association of wound worsening and Rutherford category (p = 0.030). There were association of history of coronary artery disease (CAD) with wound healing post-procedure (p = 0.014). There were no association of other factors with infrapopliteal CLI underwent plain old balloon angioplasty.

Discussion: Infrapopliteal CLI outcome underwent plain old balloon angioplasty were not yet favourable from re-stenosis, amputation rate, and wound healing. Rutherford category pre-procedure associated with wound healing after procedure."

"Latar belakang. Pada CLTI didapatkan iskemik yang progresif sehingga menyebabkan timbulnya nyeri tungkai saat istirahat dan terbentuknya ulkus atau gangren. Intervensi revaskularisasi tungkai bawah merupakan lini pertama tata laksana CLTI, dengan pilihan prosedur berupa pembedahan secara terbuka maupun tindakan endovaskular. Pasien CLTI di RSCM datang dengan kondisi lanjut dan angka reamputasi yang tinggi, sehingga diperlukan penelitian untuk mengetahui faktor yang berhubungan dengan keluaran angioplasti endovaskular yaitu penyembuhan ulkus.Metode. Studi potong lintang dilakukan di RSCM dengan melibatkan pasien CLTI Rutherford 5-6 yang menjalani tindakan angioplasti. Usia, jenis kelamin, riwayat merokok, hipertensi, fibrilasi atrium, gagal jantung, CKD, DM merupakan variabel yang diteliti terhadap penyembuhan ulkus yang merupakan penilaian klinis pascatindakan angioplasty yang dinilai adalah epitelisasi sempurna ulkus dalam kurun waktu 4 bulan pascatindakan.Hasil. Pada 133 subjek penelitian, didapatkan 60,9% pasien mengalami epitelisasi sempurna. Faktor-faktor yang memengaruhi penyembuhan ulkus pada pasien CLTI antara lain, jenis kelamin, riwayat merokok, hipertensi, fibrilasi atrium, gagal jantung, CKD, dan diabetes. Faktor yang paling berhubungan dengan penyembuhan ulkus pascaangioplasti endovaskular berdasarkan uji regresi logistik adalah diabetes.Kesimpulan. Faktor-faktor yang memiliki hubungan bermakna dengan penyembuhan ulkus pada pasien chronic limb threatening ischemia (CLTI) antara lain adalah jenis kelamin, riwayat merokok, hipertensi, fibrilasi atrium, gagal jantung, CKD, dan diabetes. Faktor yang dinilai paling berhubungan adalah diabetes melitus.

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Background. Chronic limb threatening ischemia (CLTI) can cause rest pain in lower extremities and the formation of ulcers or gangrene. Revascularization which can be done using open surgery or endovascular procedures, is the first line treatment in CLTI management. CLTI patients at RSCM usually came with advanced conditions and high re-amputation rates even after revascularization. This study aimed to determine factors associated with the outcome of endovascular angioplasty, especially ulcer healing.

Method. A cross-sectional study was conducted at RSCM involving CLTI patients with Rutherford grade 5 and 6 that underwent angioplasty. Age, gender, history of smoking, hypertension, atrial fibrillation, heart failure, chronic kidney disease (CKD), and diabetes mellitus were the independent variables studied in this study. The dependent variable was ulcer healing which is a clinical assessment after angioplasty that was assessed as complete ulcer epithelialization within four months after the procedure.

Results. In 133 study subjects, it was found that 60.9% of patients underwent complete epithelialization. Factors that affect ulcer healing in CLTI patients include gender, history of depression, hypertension, atrial fibrillation, heart failure, chronic kidney disease, and diabetes mellitus. The factor with the highest association to ulcer healing after endovascular angioplasty based on logistic regression test is diabetes mellitus.

Conclusion. Factors that have a significant relationship with ulcer healing in patients with CLTI include gender, smoking, hypertension, atrial fibrillation, heart failure, CKD, and diabetes. The factor that was considered to have the highest association was diabetes mellitus."

"Latar Belakang: Akses vaskular sebagai jalur kehidupan pasien gagal ginjal kronik yang menjalani hemodialisis dapat mengalami disfungsi. Stenosis merupakan salah satu penyebab disfungsi akses vaskular yang dapat menurunkan kualitas hemodialisis. Terapi endovaskular seperti angioplasty adalah salah satu solusi efektif untuk mengatasi masalah ini, tetapi tindakan ini memerlukan biaya yang cukup tinggi. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi keberhasilan tindakan single balloon angioplasty, yang merupakan alternatif dari tindakan angioplasty standar, pada penderita stenosis vena sentral.Metode: Penelitian ini merupakan studi kohort retrospektif analitik yang menilai faktor-faktor yang berpengaruh terhadap keberhasilan tindakan single balloon angioplasty di RSCM, RS Hermina Bekasi, RSUP Fatmawati dan RSUD Tangerang pada periode Januari 2018 sampai Desember 2020. Analisis dilakukan untuk mengidentifikasi hubungan lokasi stenosis, riwayat pemasangan kateter vena sentral, panjang lesi dan stenosis awal dengan keberhasilan tindakan single balloon angioplasty berdasarkan stenosis residual dan adekuasi hemodialisis pascatindakan.Hasil: Terdapat 109 pasien yang diinklusi dalam penelitian ini, dengan rerata usia 55,17±11,51 tahun. Dari jumlah tersebut, 58 subjek (53,2%) adalah laki-laki; 96 subjek (88,1%) memiliki komorbid hipertensi dan 38 subjek (34,9%) menderita komorbid diabetes. Pasien dengan panjang lesi >2 cm memiliki proporsi keberhasilan sebesar 21,1%, lebih rendah dibandingkan kelompok panjang lesi ≤2 cm (78,9%) (p<0,001). Derajat stenosis inisial >80% juga lebih banyak ditemukan memiliki stenosis residual ≥30% (p<0,001). Pasien dengan panjang stenosis ≤2 cm memiliki peluang keberhasilan 5,089 kali (IK 95%, 2,103–12,31) lebih tinggi dibandingkan pasien dengan panjang stenosis >2 cm. Pasien dengan derajat stenosis 50–80% memiliki peluang keberhasilan 31,62 kali (IK 95%, 7,00–142,83) lebih tinggi dibandingkan pasien dengan derajat stenosis inisial >80%. Patensi vena sentral pada 3 bulan pertama didapatkan pada 59 pasien (54,1%) dan berkurang menjadi 28,4% pada bulan ke-6 dan 9,2% pada bulan ke-12.Kesimpulan: Terdapat hubungan antara panjang lesi dan derajat stenosis inisial dengan keberhasilan tindakan single balloon angioplasty

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Background: Vascular access is the lifeline of a hemodialysis patient. Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in the hemodialysis population. Venous stenosis may result in access dysfunction, which impairs dialysis quality. Endovascular intervention such as angioplasty is an effective solution to treat this condition; however, the cost of this procedure is unacceptably high for most patients.  This study aims to identify factors affecting the success of single balloon angioplasty, which is a modification of standard angioplasty technique, for patients with central venous stenosis.

Methods: This is a retrospective analytic cohort study identifying factors affecting the success rate of single balloon angioplasty procedure in dr. Ciptomangunkusumo, Hermina Bekasi, Fatmawati, and Tangerang General Regional hospitals from January 2018 to December 2020. Statistical analysis was conducted to identify the correlation between stenosis location, previous history of central venous catheter placement, lesion length, and initial stenosis with the success rate of single balloon angioplasty according to residual stenosis and hemodialysis adequacy postoperatively.

Results: There were 109 patients included in this study, with an average age of 55.17±11.51 years. Of the 109 subjects, 58 (53.2%) were men; 96 subjects (88.1%) suffered from chronic hypertension, while 38 were diabetics. Patients with lesion length of >2 cm had a 21.1% lower success rate compared with those with lesion length of ≤2 cm (78.9%) (p<0.001). Patients with an initial stenosis of >80% was more likely to have residual stenosis of ≥30% (p<0,001). Patients with stenosis length of ≤2 cm had a 5.089-times (95% CI, 2.103–12.31) higher success rate compared with those with stenosis length of >2 cm. Patients with a degree of stenosis 50–80% had a 31.62-times (95% CI, 7.00–142.83) higher success rate compared with patients with an initial stenosis of >80%. Central venous was patent in 59 patients (54.1%) in the first 3 month and decreased to 28.4% and 9.2% in the 6th and 12th month, respectively.

Conclusion: Lesion length and the degree of initial stenosis were significantly correlated with the success rate of single balloon angioplasty."

"Latar Belakang: Akses vaskular adalah jalur kehidupan bagi pasien hemodialisis. National Kidney Foundation Dialysis Outcome Quality Initiative (NKF-KDOQI) menyatakan bahwa fistula arteriovenosa (FAV) adalah akses vaskular terbaik. Stenosis dan kegagalan maturasi FAV merupakan masalah akses hemodialisa terbanyak. Terapi endovaskular menjadi salah satu solusi dalam mengatasi masalah ini yaitu percutaneous balloon angioplasty (PTA), tetapi prosedur ini memiliki biaya yang cukup tinggi. Di Indonesia sendiri, sulit untuk bisa melakukan prosedur standard percutaneous balloon angioplasty sehingga lebih sering dilakukan prosedur PTA dengan menggunakan single balloon angioplasty, tetapi long-term patency prosedur ini belum diketahui. Penelitian ini bertujuan untuk mengetahui patensi satu tahun dari tindakan single balloon angioplasty pada pasien stenosis draining vein fistula arteriovenosa brakiosefalika.Metode: Penelitian ini merupakan studi kohort retrospektif analitik menggunakan rekam medis di RSUPN Cipto Mangunkusumo dan RS Hermina Bekasi. Variabel bebas hipertensi, diabetes mellitus, derajat stenosis, jumlah stenosis, restenosis, ukuran balon, tekanan balon, residual stenosis, lama pembuatan FAV sedangkan variabel terikat adalah patensi 1 tahun tindakan single balloon angioplasty pada stenosis juxta- dan draining vein fistula arteriovenosa brakiosefalika.Hasil: Dari 62 pasien dengan stenosis draining vein FAV brakiosefalika, didapatkan angka patensi 6 bulan dan 1 tahun pascatindakan single balloon angioplasty sebesar 33 subjek (53,2%) dan 20 subjek (32,3%). Ditemukan bahwa faktor usia FAV (lama sejak pembuatan FAV hingga stenosis) berpengaruh terhadap patensi 1 tahun paska single balloon angioplasty. Didapatkan median (min-maks) dari subjek yang tidak paten sebesar 4 bulan (1 bulan-9 bulan), sedangkan yang paten sebesar 9,5 bulan (5 bulan-36 bulan) (p=0,000).Kesimpulan: Angka patensi tindakan single balloon angioplasty pada pasien stenosis fistula arteriovenosa brakiosefalika dalam 6 bulan dan 1 tahun sebesar 53,2% dan 32,3% berturut-turut. Terdapat perbedaan lama sejak pembuatan FAV hingga stenosis yang bermakna antara kelompok yang paten selama 1 tahun dengan yang tidak paten pasca tindakan single balloon angioplasty pada stenosis fistula arteriovenosa brakiosefalika.

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Background: Vascular access is the lifeline for hemodialysis patients. The National Kidney Foundation Dialysis Outcome Quality Initiative (NKF-KDOQI) states that an arteriovenous fistula (AVF) is the best vascular access due to its high success rate and low complication rate. However, stenosis and maturation failure of an AVF are common. Endovascular therapy, namely percutaneous balloon angioplasty (PTA), is a solution to treat this problem. however, this procedure is quite costly. In Indonesia, it is difficult to perform standard percutaneous balloon angioplastyl; thus, PTA procedures are more commonly performed using single balloon angioplasty technique. However, the long-term patency of such procedure is unknown. The aim of this study was to determine the one-year patency of single balloon angioplasty in patients with draining vein stenosis in brachiocephalic arteriovenous fistula.

Methods: This study is an analytic retrospective cohort using medical records at Cipto Mangunkusumo General Hospital and Hermina Hospital Bekasi. The independent variables were hypertension, diabetes mellitus, degree of stenosis, number of stenosis, restenosis, balloon size, balloon pressure, residual stenosis, duration of fistula creation. The dependent variable was a 1-year patency of single balloon angioplasty in juxta and draining vein stenosis of brachiocephalic arteriovenous fistula.

Results: Out of 62 patients with draining vein stenosis of brachiocephalic AVF, 6 months and 1 year of patency after single-balloon angioplasty were 33 (53.2%) and 20 subjects (32.3%), respectively. Age of the fistula, namely the duration from the arteriovenous fistula creation until stenosis, had a statistically significant influence on 1-year patency after single balloon angioplasty. By using numerical data from the length of the month of fistula creation, the median (min-max) of the non-patent subjects was 4 months (1 month-9 months), while the patent ones was 9.5 months (5 months - 36 months) (p=0.000).

Conclusion: The patency rates of single balloon angioplasty in patients with draining vein stenosis of brachiocephalic arteriovenous fistula at 6 months and 1 year were 53.2% and 32.3%, respectively. There was a significant difference in the length of time from arteriovenous fistula creation to stenosis between the patented group for 1 year and the non-patent group after single balloon angioplasty in draining vein stenosis of brachiocephalic arteriovenous fistula.

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"Tujuan. Penelitian ini dibuat untuk mengetahui faktor-faktor yang berhubungan patensi satu tahun Single Balloon Angioplasty (SBA) pada Stenosis Draining Vein Fistula Arteriovenosa (FAV) RadiosefalikaMetode. Penelitian ini merupakan studi kohort retrospektif, yang dilakukan di RSUPN Cipto Mangunkusumo Jakarta, RSUP Fatmawati, dan RS Hermina Bekasi pada bulan Juli-November 2022. Pasien ≥ 18 tahun yang pertama kali didiagnosis stenosis juxta dan draining vein FAV radiosefalika diinklusi dalam penelitian. Variabel yang diteliti adalah lama pembuatan FAV hingga terjadi stenosis, karakteristik stenosis (jumlah, panjang, derajat, dan diameter), serta peningkatan flow dan sisa residual stenosis pasca angioplasti. Bila pada analisis bivariat didapatkan p<0,25 maka akan dilanjutkan ke analisis multivariat menggunakan regresi logistik.Hasil. Peneliti menginklusi 110 pasien disfungsi FAV radiosefalika pada draining vein yang menjalani tindakan SBA, dengan median usia 59 (30–82) tahun. Patensi FAV radiosefalika pasca tindakan SBA pada bulan ke-3, bulan ke-6, dan bulan ke-12, masing-masing sebesar 87,3, 74,5%, dan 42,7%. Faktor-faktor yang ditemukan berhubungan dengan patensi adalah riwayat diabetes (aOR=26,610, IK95% 2,992–236,681), jumlah stenosis (aOR=17,329, IK95% 2,204–136,242), panjang stenosis ≥ 2 cm (aOR=14,993, IK95% 1,808–124,351), durasi FAV < 6 bulan (aOR=86,094, IK95% 7,729–959,044), diameter stenosis ≥ 2,685 mm (aOR=8,900, IK95% 1,515–52,287), dan residual stenosis ≥30% (aOR=250,241, IK95%, 6,129–10.216,612).Simpulan. Angka patensi 1 tahun tindakan SBA pada pasien dengan FAV radiosefalika yang mengalami stenosis draining vein adalah sebesar 42,7%. Residual stenosis ≥30% pasca tindakan merupakan faktor yang paling berpengaruh dalam menentukan patensi FAV 12 bulan pasca tindakan

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Aim. This study aimed to determine the factors related to one year patency of Single Balloon Angioplasty (SBA) in Radiocephalic Arteriovenous Fistula Draining Vein Stenosis (FAV).

Methods: This is a retrospective cohort study, which was conducted at Cipto Mangunkusumo, Fatmawati, and Hermina Bekasi Hospital General Hospital in July–November 2022. Patients aged ≥ 18 years who were firstly diagnosed with juxta and draining vein FAV radiocephalics stenosis were included in the study. The variables studied were the duration of FAV placement until stenosis occurred, the characteristics of the stenosis (number, length, degree, and diameter), as well as increased flow and residual stenosis after angioplasty. If the bivariate analysis obtained p <0.25 then it will be continued to multivariate analysis using logistic regression.

Results: We included 110 patients with radiocephalic FAV dysfunction in the draining vein who underwent SBA, with a median age of 59 (30–82) years. The patency of radiocephalic FAV after the SBA procedure at the 3rd, 6th, and 12th months, were 87.3, 74.5%, and 42.7%, respectively. Factors associated with patency were history of diabetes (aOR=26.610, CI95% 2.992–236.681), number of stenoses (aOR=17.329, CI95% 2.204–136.242), length of stenosis ≥2 cm (aOR=14.993, CI95% 1.808) –124.351), duration of FAV <6 months (aOR=86.094, CI95% 7.729–959.044), diameter of stenosis ≥2.685 mm (aOR=8.900, CI95% 1.515–52.287), and residual stenosis ≥30% (aOR=250.241, CI95 %, 6,129–10,216,612).

Conclusion: The 1-year patency rate for SBA in patients with radiocephalic FAV who have stenosis of the draining vein is 42.7%. Residual stenosis ≥30% postoperatively is the most influential factor in determining FAV patency 12 months postoperatively."

"Pengantar. Penelitian ini dilakukan dengan tujuan untuk membedakan efektifitas dan keamanan single balloon angioplasty (SBA) dengan akses arterial inflow dan vena outflow pada pasien PGK yang menjalani hemodialisis dengan disfungsi radiocephalic AVF.Metode. Penelitian ini dilaksanakan pada bulan April-Juni 2022 dengan desain observasional retrospektif, di Unit Rekam Medis RS Cipto Mangunkusumo, RS Hermina Bekasi, dan RS Prof. Dr. R.D. Kandou Manado. Semua pasien dengan penyakit ginjal kronis stadium akhir (pada terapi hemodialisis) yang memiliki fistula arteriovenosa disfungsional radiosefalik (AVF). Variabel terikat dalam penelitian ini adalah keberhasilan AVF setelah terapi endovaskular (SBA) yang dinilai berdasarkan kriteria KDOQI NKF, patensi AVF, dan komplikasi pada pasien setelah terapi endovaskular.Hasil. Sebanyak 178 pasien dengan disfungsi AVF radiosefalik dilibatkan. Tingkat keberhasilan untuk SBA ditemukan lebih tinggi pada kelompok aliran arteri, dengan rasio odds (OR) 2,539 (95% CI 1,100-5,858). Tingkat patensi pada 3 dan 6 bulan setelah SBA dengan akses aliran arteri ditemukan lebih tinggi dibandingkan dengan akses aliran keluar vena (p 0,05). Tidak ada pengaruh jenis akses ini pada patensi 12 bulan setelah prosedur SBA (p = 0,991). Tidak ada perbedaan yang signifikan dalam tingkat komplikasi SBA dengan akses ke aliran masuk arteri dan aliran keluar vena pada pasien CKD dengan disfungsi AVF.Simpulan. Tingkat keberhasilan, patensi 3 bulan, dan SBA 6 bulan pasca operasi ditemukan lebih tinggi dengan akses aliran masuk arteri.

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Introduction. This study was conducted with the aim of differentiating the effectiveness and safety of single balloon angioplasty (SBA) with access to arterial inflow and venous outflow in CKD patients on hemodialysis with radiocephalic AVF dysfunction.

Methode. This research was conducted in April-June 2022 with an observational retrospective design, at the Medical Record Unit of Cipto Mangunkusumo Hospital, Hermina Hospital Bekasi, and Prof. Hospital. Dr. R.D. Kandou Manado. All patients with end-stage chronic kidney disease (on hemodialysis therapy) who have a radiocephalic dysfunctional arteriovenous fistule (AVF). The dependent variable in this study was the success of AVF after endovascular therapy (SBA) which was assessed based on the KDOQI NKF criteria, AVF patency, and complications in patients after endovascular therapy.

Results. A total of 178 patients with radiocephalic AVF dysfunction were included. The success rate for SBA was found to be higher in the arterial inflow group, with an odds ratio (OR) of 2.539 (95% CI 1.100–5.858). The rate of patency at 3 and 6 months after SBA with arterial inflow access was found to be higher than with venous outflow access (p 0.05). There was no effect of this type of access on the patency of 12 months after the SBA procedure (p = 0.991). There was no significant difference in the complication rate of SBA with access to arterial inflow and venous outflow in CKD patients with AVF dysfunction.

Conclusion. The success rates, 3-month patency, and 6-month postoperative SBA were found to be higher with arterial inflow access."

"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

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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"

"Untuk hemodialisis pasien Penyakit Ginjal Tahap Akhir (PGTA) akses vaskular terpilih adalah pembuatan fistula arteriovenosa (FAV) native, namun FAV memiliki angka kegagalan maturitas yang relatif tinggi. Primary balloon angioplasty (PBA) merupakan salah satu teknik dilatasi untuk membantu maturitas FAV. Teknik konstruksi FAV yang traumatik dan peregangan diameter lumen vena dengan balon dapat menyebabkan cedera fokal pada endotelium vena dan memberikan respons hiperplasia intima serta memengaruhi kadar NO, VEGF dan EMP yang dapat berdampak negatif pada maturitas FAV. Penelitian ini bertujuan untuk mengetahui efek PBA terhadap hiperplasia intima, kadar NO, VEGF, EMP serta maturitas FAV pada pasien dengan PGTA.Desain penelitian adalah uji klinis tersamar acak tunggal di RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok pada bulan Desember 2019 sampai Februari 2022; dengan subjek penelitian 112 pasien. Setelah randomisasi sampel terstratifikasi, 48 pasien menjalani konstruksi FAV dengan PBA (intervensi) dan 64 pasien menjalani konstruksi FAV tanpa PBA (kontrol). Pengukuran meliputi intimal medial thickness (IMT) jukstaanastomosis, VF dan PSV draining vein 1, 2 dan 6 minggu pascaoperasi; kadar NO, kadar VEGF, kadar EMP pascaoperasi dan 2 minggu pascaoperasi serta maturitas FAV yang dievaluasi 6 minggu pascaoperasi. Terkait pandemi COVID-19, 32 pasien lost to follow-up dan 5 pasien kontrol dieksklusi karena trombus pada FAV sehingga subjek yang dianalisis 36 pasien intervensi dan 39 pasien kontrol.Terdapat perbedaan bermakna antara grup kontrol dan intervensi pada maturitas, VF dan PSV draining vein 6 minggu pascaoperasi; kadar EMP 2 minggu pascaoperasi pada pasien PGTA yang menjalani operasi konstruksi FAV (Uji Mann Whitney U, p < 0,05). Tidak didapatkan perbedaan bermakna IMT jukstaanastomosis serta kadar NO dan VEGF antara kelompok kontrol dan intervensi (Uji Mann Whitney U, p > 0,05).Simpulan: PBA meningkatkan maturitas FAV pada pasien PGTA yang menjalani operasi konstruksi FAV yang ditandai dengan peningkatan VF dan PSV draining vein hingga 6 minggu pascaoperasi tanpa memengaruhi ketebalan intima pada daerah jukstaanastomosis, kadar NO dan kadar VEGF. Terdapat peningkatan kadar EMP 2 minggu pascaoperasi pada FAV dengan PBA.

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The preferred vascular access for hemodialysis for patients with end-stage renal disease (ESRD) is through the creation of a native arteriovenous fistula (AVF). The weakness of AVF is the relatively high maturation failure rate. Primary balloon angioplasty (PBA) is a dilation technique to assist AVF maturation. Traumatic AVF construction technique and diameter stretching of the vein lumen with balloons can cause focal injury to the venous endothelium which will eventually affect intimal hyperplasia and NO, VEGF and EMP levels which can negatively impact AVF maturation. This study aimed to determine the effect of PBA on intimal hyperplasia, levels of NO, VEGF, EMP and AVF maturation in patients with ESRD who underwent AVF construction surgery.

This study used a single-blind randomized clinical trial design at RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok in December 2019 until February 2022 with 112 subjects. With stratified sample randomization method, 48 patients underwent AVF construction with PBA (intervention), 64 patients underwent AVF construction without PBA (control). Measurements included jukstaanastomosis intimal medial thickness (IMT), VF and peak systolic value (PSV) draining veins 1, 2 and 6 weeks postoperatively; NO, VEGF, EMP levels postoperative and 2 weeks postoperative; and AVF maturation evaluated 6 weeks postoperatively. Regarding the COVID-19 pandemic, 32 patients lost to follow-up and 5 control patients were excluded because of thrombus in the AVF so that analysis was carried out on 75 subjects (36 intervention patients and 39 control patients).

There were significant differences between control and intervention groups in maturity, VF and PSV draining vein 6 weeks postoperatively; EMP levels 2 weeks postoperatively in ESRD patients undergoing AVF construction (Mann Whitney U, p < 0,05). There were no significant differences in jukstaanastomosis IMT; NO and VEGF levels between control and intervention groups (Mann Whitney U, p > 0.05).

Conclusion: PBA increases the maturity of the arteriovenous fistula in ESRD patients undergoing AVF construction surgery which is characterized by an increase in VF and PSV draining veins up to 6 weeks postoperatively without affecting the IMT in jukstaanastomosis area, NO and VEGF levels. There was an increase in EMP levels 2 weeks postoperatively in AVF with PBA."

"Introduction: Central venous stenosis (CVS) or occlusion is a severe complication in hemodialysis patients, which significantly decreases the patency of all vascular dialysis access components, including arteries and branches, AV anastomosis, peripheral veins, and central veins. The main etiology of CVS is mostly secondary to the placement of temporary or permanent dialysis catheters in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy for central venous stenosis is conventional balloon angioplasty. Method: This is a retrospective study using medical records from June 2013 to August 2018. Patients who underwent plain old balloon angioplasty (POBA) procedures in the CVS condition due to the installation of hemodialysis catheter access were included in this study. The analysis was performed to assess the characteristics and data distribution of each variable. Results: Significant factors related to the success of endovascular procedure in patients with central venous stenosis with POBA were the onset of clinical symptoms (<3 months; p <0.001), duration of catheter placement (<2.5 months; p <0.001), history of previous catheter placement (no more than once, p <0.001), initial stenosis (<80; p <0.001), and diameter of POBA (≥ 10 mm; p <0.001). Conclusion: Some factors influenced the success of the POBA procedure for overcoming CVS. The need to understanding the use of hemodialysis catheter access according to the guideline is important."