Tesis

Pengaruh Lokasi Stenosis Cephalic Arch Terhadap Keberhasilan Angiplasty serta Patensi 3 dan 6 bulan pada Pasien dengan Fistula Brachiocephalica = The Effect of Cephalic Arch Stenosis Location on Angioplasty Success and 3- and 6-Month Patency in Patients with Brachiocephalic Fistula.

Latar Belakang. Kegagalan maturasi dan stenosis merupakan hambatan utama terhadap patensi fistula arteriovenosa pada pasien hemodialisa. Cephalic arch umum mengalami disfungsi vaskular dan dapat dibagi menjadi empat domain. Namun, belum ada studi yang meneliti pengaruh lokasi stenosis cephalic arch terhadap keberhasilan angioplasty di Indonesia. Tujuan. Studi ini bertujuan untuk mengetahui hubungan lokasi stenosis cephaic arch terhadap keberhasilan angioplasty serta patensi 3 dan 6 bulan pada pasien dengan fistula braciocephalica serta faktor – faktor yang memengaruhinya. Metode. Studi kohort retrospektif ini melibatkan 68 pasien stenosis cephalic arch dengan fistula braciocephalica dari poli atau rawat inap RSCM periode Januari 2022 hingga Desember 2024. Pengambilan data menggunakan rekam medik. Analisis bivariat dengan Uji ChiSquare atau Fischer dan analisis multivariat dengan Firth logistic regression. Hasil. Tingkat keberhasilan angioplasty adalah 91,2%, dengan tingkat patensi 3 bulan sebesar 87,1% dan tingkat patensi 6 bulan sebesar 66,7%. Dari analisis multivariat, penggunaan stent diasosiasikan signifikan dengan berkurangnya patensi 3 bulan pasca angioplasty (OR 0,12; 95% CI 0,02–0,93; p = 0,042), dan sudut insersi cephalic arch ≥ 60 menurunkan patensi 6 bulan pasca angioplasty (OR 0,23; 95% CI 0,06–0,77; p = 0,017). Simpulan. Lokasi stenosis, usia, jenis kelamin, derajat stenosis, panjang stenosis, sudut insersi cephalic arch, jumlah balon, ukuran balon, tekanan balon, jenis balon, penggunaan stent, hipertensi, dan diabetes tidak berhubungan terhadap residual stenosis, patensi 3 bulan, dan patensi 6 bulan pasca angioplasty.
Kata Kunci: Lokasi stenosis, stenosis cephalic arch, angioplasty, patensi, fistula brachiocephalica, hemodialisa


Background. Failure of maturation and stenosis are major obstacles to arteriovenous fistula patency in hemodialysis patients. The cephalic arch commonly develops vascular dysfunction and can be divided into four domains. However, no study in Indonesia has evaluated the effect of cephalic arch stenosis location on angioplasty outcomes. Objective. This study aimed to determine the relationship between the location of cephalic arch stenosis and angioplasty success, as well as 3- and 6-month patency in patients with brachiocephalic fistulas, and to identify influencing factors. Methods. This retrospective cohort study included 68 patients with cephalic arch stenosis and brachiocephalic fistulas treated in outpatient clinics or inpatient wards at Cipto Mangunkusumo Hospital (RSCM) from January 2022 to December 2024. Data were obtained from medical records. Bivariate analysis was performed using the Chi-square or Fisher’s exact test, and multivariate analysis was conducted using Firth logistic regression. Results. The angioplasty success rate was 91.2%, with 3-month patency of 87.1% and 6- month patency of 66.7%. Multivariate analysis showed that stent use was significantly associated with reduced 3-month patency after angioplasty (OR 0.12; 95% CI 0.02–0.93; p = 0.042), and a cephalic arch insertion angle ≥60° was associated with decreased 6- month patency after angioplasty (OR 0.23; 95% CI 0.06–0.77; p = 0.017). Conclusion. Stenosis location, age, sex, degree and length of stenosis, cephalic arch insertion angle, number of balloons, balloon size, balloon pressure, balloon type, stent use, hypertension, and diabetes were not associated with residual stenosis or with 3- and 6-month patency after angioplasty.
Keywords: stenosis location, cephalic arch stenosis, angioplasty, patency, brachiocephalic fistula, hemodialysis