Title：Functional Outcomes of Arteriovenous Fistulas Created by Nephrologist.
Background ：Nephrologists worldwide, after undergoing surgical training, have reported creating arteriovenous fistulas (AVFs).
Objective：To demonstrate the functional outcome of arteriovenous fistulas created by a trained Nepalese nephrologist.
Method ：This was a cross sectional study. A convenient sampling method was used and all consecutive AVFs created by a single nephrologist from January 2016 to December 2018 were included to assess their functional status within 3 months of creation. Patients with incomplete data and no follow up for up to 3 months post surgery were excluded.
Result ：One hundred sixty six (166) arteriovenous fistulas were created during the study period; mean age of the patients was 52 ± 14 years, 121 (75%) male and 65 (39%) were diabetic. The most common site of arteriovenous fistula creation was left radiocephalic (Lt RC) 69(41.5%), followed by left brachiocephalic (Lt BC) 66(39.7%). Other sites were left brachiobasilic (Lt BB) 10(6%), right brachiocephalic (Rt BC) 10(6%), right radiocephalic (Rt RC) 9(5.4%) and right brachiobasilic (Rt BB) 2(1.2%). 139 arteriovenous fistulas (83.7%) were functional within 3 months post creation. Functional outcomes of radiocephalic, brachiocephalic and brachiobasilic arteriovenous fistulas were 75.6%, 90.7% and 100% respectively at 3 months post creation. Lymphoceles developed in three Lt BC arteriovenous fistulas, thrombosis in two Lt BC arteriovenous fistulas and infection in two Lt BC arteriovenous fistulas with pseudoaneurysm formation.
Source：Kathmandu Univ Med J (KUMJ) 2020 Apr-Jun; 18(70):155-159.
背景：众所周知，肾脏科医生在接受外科手术训练后，均可建立动静脉内瘘（AVF）。
目的：证明由训练有素的尼泊尔肾脏科医生创建的动静脉瘘的功能结果。
方法：这是一项横断面研究。使用了一种方便的采样方法，并纳入了由一名肾脏科医生从2016年1月至2018年12月连续创建的所有AVF，以评估其在建立后3个月内的功能状态。数据不完整且在术后3个月内、没有随访的患者被排除在外。
结果：在研究期间内，共产生了166例动静脉内瘘。患者的平均年龄为52±14岁，其中121位男性（占75％）和65位糖尿病（占39％）。动静脉瘘形成的最常见部位是左桡头（Lt RC）69（41.5％），其次是左肱头（Lt BC）66（39.7％）。其他部位分别为左肱贵要（Lt BB）10（6％），右肱头（Rt BC）10（6％），右桡头（Rt RC）9（5.4％）和右肱头（Rt BB）2（1.2％） 。在建立后的三个月内，有139例动静脉瘘（83.7％）实现功能作用。在建立后三个月，桡头，肱头和肱贵要动脉动静脉瘘的功能结局分别为75.6％，90.7％和100％。淋巴囊肿发生于3个Lt BC动静脉瘘中，血栓形成于两个Lt BC动静脉瘘中，而两个Lt BC动静脉瘘中则有假性动脉瘤形成。
结论：由训练有素的尼泊尔肾脏病专家建立的动静脉内瘘的功能结局与文献报道相似。
启发：限制技术开展的，不是专业类型、不是地区地域，而是政策支持、学习机会和个人的态度。
