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"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: Endovascular repair of abdominal aortic aneurysms (EVAR) menggunakan stent graft merupakan terapi utama pada pasien dengan aneurisma aorta abdominal. Aplikasi klinis EVAR dihadapkan dengan tingginya variasi anatomik aneurisma yang menyebabkan ketidaksesuaian ukuran stent yang dapat menyebabkan komplikasi berupa endoleak. Pembuatan instructions for use (IFU) merupakan upaya standardisasi dari produsen stent sehingga dapat sesuai dengan kondisi anatomik pasien dan menghindari komplikasi. Belum adanya penelitian mengenai kesesuaian IFU pada EVAR dan keluaran operasinya khususnya endoleak pasca-EVAR. Penelitian ini ditujukan untuk melihat hubungan kesesuaian IFU pada EVAR dengan kejadian endoleak pasca-EVAR.Metode: Studi dilakukan secara kohort retrospektif yang menilai hubungan kesesuaian IFU pada EVAR dengan kejadian endoleak pasca-EVAR. Penelitian akan dilakukan dari bulan Desember 2018-Februari 2019 di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Pengambilan subjek dilakukan dengan pengambilan subjek total.Hasil: Pada pengambilan subjek didapatkan 39 subjek yang menjalani prosedur EVAR. Pada penelitian ini didapatkan 27 subjek (69.2%) menjalani EVAR sesuai dengan IFU dan 12 subjek (30.8%) tidak sesuai dengan IFU. Pada penelitian ini didapatkan 3 subjek penelitian (7.7%) mengalami endoleak pasca-EVAR. Pada analisis data, ditujukan bahwa kesesuaian IFU dalam menjalani EVAR tidak menunjukan hubungan yang bermakna dengan kejadian endoleak pasca-EVAR (p=0.539). Pada penelitian ini didapatkan bahwa seluruh pasien yang mengalami endoleak pasca-EVAR berasal dari kelompok yang menjalankan IFU yang sesuai. Analisis data panjang, sudut, dan diameter leher juga tidak menunjukan hubungan yang bermakna dengan kejadian endoleak pasca-EVAR.Kesimpulan: Tidak terdapat adanya hubungan antara kesesuaian IFU dalam menjalani EVAR dengan kejadian endoleak pasca-EVAR.

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Background: Endovascular repair of abdominal aortic aneurysms (EVAR) with stent-graft is the main treatment for patients with abdominal aortic aneurysm. Clinical application of EVAR is faced with the wide anatomic variety of aneurysm that could lead to incompatibility of stent size that could cause complications like endoleak. Instruction of use (IFU) is a standardization effort from the producer of the stent so that it would be more suitable for the patients anatomical condition thus avoiding the complications. Up until now, there has not been a research that studied the use of IFU on EVAR and its post-surgical outcome, especially post-EVAR endoleak. The objective of this study is to see the association between IFU accordance in EVAR with post-EVAR endoleak.Method: The study was conducted by cohort-retrospective which assesses the association between IFU accordance in EVAR with post-EVAR endoleak. This study was done from December 2018 to February 2019 at vascular surgery out-patient clinic in Cipto Mangunkusumo Hospital. Total sampling was conducted to obtain subjects by collecting all patients treated by EVAR.Results: There were 39 subjects selected in this study. We found 27 subjects (69.2%) underwent EVAR appropriately according to IFU and 12 subjects (30.8%) that did not. Three of the subjects (7.7%) had post-EVAR endoleak. In the data analysis, IFU accordance in EVAR did not have a significant association with post-EVAR endoleak incidence (p=0.539). This study also found that every single subject with post-EVAR endoleak was from the IFU appropriate EVAR group. Data analysis on neck length, angle, and diameter also did not show any significant association with post-EVAR endoleak incidence (p>0.05).Conclusion: There is no association between IFU accordance in EVAR with post-EVAR endoleak. Another study with larger sample size is needed to show association between IFU accordance with post-EVAR endoleak more accurately."

"Latar belakang: Intervensi endovaskular aorta perkutan rutin dilakukan dan menjadi pilihan tatalaksana invasif aneurisma atau diseksi aorta serta penyakit katup aorta. Komplikasi vaskular pasca intervensi sering terjadi pada pasien dengan diameter arteri femoralis komunis yang lebih kecil. Namun terdapat perbedaan bermakna dari diameter arteri femoralis komunis antara populasi Kaukasia dan Asia terkait komplikasi vaskular. Pada populasi Indonesia belum ada data terkait diameter arteri femoralis komunis dengan komplikasi vaskular. Tujuan: Mengetahui diameter minimal arteri femoralis komunis sebagai prediktor komplikasi vaskular pasca intervensi endovaskular aorta perkutan pada populasi Indonesia. Metode: Pasien yang dilakukan intervensi endovaskular aorta perkutan, diukur diameter arteri femoralis komunis dengan CT scan. Pasien dievaluasi kejadian komplikasi vaskular selama perawatan pasca tindakan. Hasil: Terdapat 101 pasien dengan 135 arteri femoralis komunis yang menjadi sampel penelitian. Dibagi menjadi dua kelompok ukuran diameter arteri femoralis komunis berdasarkan median 7,6 mm, yaitu diameter ≥7,6 mm dan diameter <7,6 mm. Dari analisis multivariat, tidak terdapat hubungan bermakna antara kategori diameter arteri femoralis komunis dengan komplikasi vaskular pasca intervensi endovaskular aorta perkutan (p 0,38). Variabel lain yang berhubungan dengan kejadian komplikasi vaskular adalah jenis kelamin perempuan (p 0,03) dan RSAF ≥0,82 (p <0,001). Kesimpulan: Diameter arteri femoralis komunis tidak dapat menjadi prediktor kejadian komplikasi vaskular pasca intervensi endovaskular aorta perkutan pada populasi Indonesia karena berdasarkan analisis multivariat tidak ditemukan hubungan yang bermakna.

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Background: Percutaneus endovascular aorta repair has been routinely performed and become the primary choice of invasive therapy for aortic aneurism, aortic dissection and aortic valve disease. The occurrence of vascular complications resulting from intervention, often occurs in patients with smaller common femoral artery. However there is a significant difference in the diameter of common femoral artery between the Caucasian and Asian populations related to the incidence of vascular complications. Objectives: To investigate the minimal diameter of common femoral artery as a predictor of vascular complications after percutaneus endovascular aorta repair in the Indonesian population. Methods: Patients who performed percutaneus endovascular aorta repair, measured the diameter of the common femoral artery with a CT scan and than evaluated for the occurrence of vascular complications after procedure. Results: 101 patients with 135 common femoral arteries are divided into two groups based on median of common femoral arteries (7,6 mm), diameter ≥7,6 mm and diameter <7,6 mm. From multivariate analysis, there is no significant association between the common femoral artery diameter and vascular complications after percutaneous aortic endovascular repair (p 0,38). Other variables that related to the incidence of vascular complications were female (p 0.03) and RSAF ≥0.82 (p <0.001). Conclusion: Diameter of common femoral artery can not be used as predictor of vascular complications after percutaneus endovascular aorta repair in the Indonesian population because based on multivariate analysis there was no significant relationship."

"Latar belakang: Chronic limb threatening ischemia (CLTI) merupakan bentuk terparah peripheral arterial disease. Pasien kaki diabetik dengan CLTI memiliki risiko amputasi mayor dan mortalitas paska revaskularisasi dan dipengaruhi beberapa faktor seperti usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi. Indonesia belum memiliki data amputasi mayor dan mortalitas kaki diabetik dengan CLTI setelah revaskularisasi dan faktor-faktor yang berpengaruh. Penelitian ini bertujuan mengetahui angka amputasi mayor dan mortalitas satu tahun pasca revaskularisasi beserta faktor-faktor yang memengaruhi di Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Kohort retrospektif pasien kaki diabetik dengan CLTI setelah revaskularisasi di RSCM Januari 2010 – Desember 2020. Pengambilan data rekam medis. Luaran utama amputasi mayor dan mortalitas satu tahun setelah revaskularisasi. Dilakukan analisis bivariat dengan uji Kai Kuadrat, jika persyaratan tidak terpenuhi maka menggunakan Fischer-exact, variabel bermakna diuji lebih lanjut dengan regresi logistik. Hasil: Penelitian melibatkan 150 subjek. Amputasi mayor dan mortalitas satu tahun setelah revaskularisasi sebesar 27,3% dan 24,7%. Tidak didapatkan hubungan yang bermakna antara faktor-faktor yang diteliti dengan amputasi mayor dan mortalitas satu tahun.Kesimpulan: Didapatkan angka amputasi mayor dan mortalitas 1 tahun pasca revaskularisasi. Usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi bukan merupakan faktor yang memengaruhi angka amputasi dan mortalitas satu tahun.

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Background: Chronic limb threatening ischemia (CLTI) is the most severe form of peripheral arterial disease. Diabetic foot patients with CLTI have major amputation and mortality risk after revascularization and affected by factors such as elderly, chronic kidney disease (CKD), cardiac morbidity and hypertension. In Indonesia there are no data regarding diabetic foot major amputation and mortality with CLTI after revacularization and influencing factors. Study aims to determine one year major amputation and mortality and factors that can affect diabetic foot pastients with CLTI after revascularization.

Methods: Retrospective cohort study on diabetic foot patients with CLTI undergoing revascularization at Cipto Mangunkusumo National Hospital from January 2010 to December 2020. The primary outcome was one-year major amputation and mortality after revascularization. Factors included were age, CKD, cardiac comorbidity and hypertension. We conducted bivariate analysis using Chi Square or Fisher-exact test. Variables were further tested using multivariate test.

Result: 150 subjects were enrolled. One-year major amputation and mortality was 27.3% and 24.7%. There are not significant correlations between factors with major amputation and mortality.

Conclusion: Major amputation and mortality rate one year after revascularization at RSCM are gained. Elderly, CKD, cardiac comorbidity and hypertension are not factors affecting one-year major amputation and mortality."

"Latar Belakang: Chronic limb threatening ischemia (CLTI) merupakan bentuk paling parah dari peripheral arterial disease (PAD). Sebanyak 25% pasien CLTI memiliki risiko amputasi tungkai mayor dan 25% lainnya akan meninggal karena penyakit kardiovaskular dalam 1 tahun. Risiko amputasi ini dapat diprediksi menggunakan sistem skoring Wound, Ischemia, and foot Infection (WIfI). Penelitian ini bertujuan untuk mendapatkan profil amputasi menggunakan skor Wound, Ischemia, foot Infection pada subjek chronic limb threatening ischemia di Rumah Sakit dr. Cipto Mangunkusumo (RSCM).Metode: Pengambilan data retrospektif dari data registrasi divisi bedah vaskular dan rekam medis pada subjek dengan CLTI di RSCM berupa profil subjek, skor WIfI, dan status amputasi mayor dalam 1 tahun pasca diagnosis CLTI ditegakkan. Data selanjutnya dimasukkan ke program SPSS, dan dilakukan analisa data. Hasil analisa lalu dipaparkan dalam bentuk narasi dan tabel.Hasil: Pada penelitian ini usia rerata subjek adalah 58,1 ± 12,9 tahun dengan predominasi jenis kelamin laki-laki (58,3%). Komorbid pada subjek dari yang tersering adalah diabetes (82,1%), hipertensi (67,9%), gagal ginjal kronis (51,3%), dan penyakit jantung (33%). Derajat skor WIfI dengan derajat sangat rendah, rendah, sedang, dan tinggi secara berurutan adalah 6,4%, 9,6%, 35,9%, dan 48,1%. Angka amputasi mayor yang sesungguhnya pada subjek CLTI di RSCM untuk skor WIfI derajat sangat rendah, rendah, sedang, dan tinggi adalah 5%, 7%, 35%, dan 70%, sedangkan pada kepustakaan adalah 3%, 8%, 25%, dan 50%.

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Background: Chronic limb threatening ischemia (CLTI) is the most severe form of peripheral arterial disease (PAD). As many as 25% of CLTI patients have a risk of major limb amputations and 25% will die due to cardiovascular event within 1 year. The risk of this major amputation can be predicted using the Wound, Ischemia, and foot Infection (WIfI) scoring system. This study aims to compare the amputation profile using Wound, Ischemia, foot Infection scores in chronic limb threatening ischemia patients at the RSCM.

Methods: Retrospective data collection from registry in vascular surgery division and medical records for patients with CLTI in RSCM were take, that is a patient profile, the comorbid disease, WIfI score, and the patient's major amputation status within 1 year after diagnosis of CLTI was established. The data then inputed to the SPSS program, and data analysis is performed. The results of the analysis are then presented in the form of narratives and tables.

Result: The mean age of the subjects in this study was 58,1 ± 12,9 years with male as gender predominance (58,3%). The comorbids in the subjects were diabetes (82,1%), hypertension (67,9%), chronic kidney failure (51,3%), heart disease (33%). The WIfI scores with very low, low, medium, and high degrees are 6,4%, 9,6%, 35,9%, and 48,1% respectively. The major amputation rates in for WIfI scores with very low, low, medium, and high degrees are 5%, 7%, 35%, and 70%, while in the literature are 3%, 8%, 25%, and 50%."

"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%).

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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%)."

"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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"The research was focussed on the effects of production , trade and macro economic policies on the real price, level of protection and the achievement of estate crop commodities, naeley cocoa, coffee, rubber, tea and crude palm oil (CPO), in the Indonesian domestic market. The method of analyses used includes the decomposition of relative prices of estate crop commodities and direct, indirect and total protection rates. The results show that the real prices of main estate crops in the period of 1985 - 1997 experienced, a decrease compared to that 1979 - 1985. However in the period of 1997 - 2005, the real prices of cocoa and rubber, but not for coffee , tea and CPO , showed an increase compared to the preceding periods. The indirect protection , in general indicated an increase, however, the direct protection, showed a decrease. In total , the rate protection of the estate crops resulted in positive value eventhough it seamed to decrease from time to time. Term of trade of estate crops againts the importing sugar, from 1979 to 1997 showed a decrease but they were still in positive values. The decreasing performance o of main estate crops would be more significant with respect to the capacity to import. In the future , it is suggested , it is seggested that the government of Indonesia should adjust its interventions continuosly by taking into account tha international price movements of main estate crops to give incentives t to producers and exporters. in general indicated "

"Tesis ini membahas metode dalam mengukur dampak proyek yang melakukan intervensi mata pencaharian terhadap pendapatan. Studi Kasus yang digunakan adalah Proyek PULIH di Kabupaten Belu dan NTT, dimana proyek ini melakukan intervensi di 28 desa selama 26 bulan. Intervensi mata pencaharian dilakukan sebagai salah satu usaha dalam mengurangi kemiskinan dan kerentanan, khususnya di kalangan pengungsi internal (IDPs) yang tidak dapat kembali ke wilayah asalnya. Studi ini merupakan gabungan studi kualitatif dengan metode wawancara dan kunjungan lapangan serta studi kuantitiatif dengan metode regresi data panel dan metode statistik dekriptif dengan metode perbandingan rata-rata. Hasil penelitian menunjukkan bahwa faktor yang mempengaruhi mata pencaharian adalah musim. Sementara itu Proyek PULIH secara kualitatif telah memberi dampak positif mata pencaharian masyarakat intervensinya, khususnya dalam menghadapi kerentanan yang diakibatkan oleh musim.

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This thesis discusses methods for measuring the impact of projects that carry out livelihood interventions on income. The case study used is the PULIH Project in Belu District and NTT, where the project intervened in 28 villages for 26 months. Livelihood interventions are carried out as one of the efforts to reduce poverty and vulnerability, especially among internally displaced persons (IDPs) who cannot return to their home areas. This study is a combination of qualitative studies with interview methods and field visits as well as quantitative studies using panel data regression methods and descriptive statistical methods with average comparison methods. The results of the study indicate that the factors that affect livelihoods are seasons. Meanwhile, the PULIH Project has qualitatively had a positive impact on the livelihoods of its intervention communities, particularly in dealing with vulnerabilities caused by seasons."

"Perawat Spesialis Medikal Bedah berperan penting dalam praktik keperawatan sebagai pemberi asuhan keperawatan kompleks, melakukan analisa ilmiah dan pembuktian ilmiah serta sebagai agen pembaharu. Melalui tulisan ini digambarkan pemberian asuhan keperawatan kepada pasien dengan diagnosis Chronic Limb Threatening Ischemia. Tujuan dari penulisan ini adalah memberikan gambaran praktek keperawatan spesialis medikal bedah menggunakan pendekatan Model Adaptasi Roy. Dari hasil pengumpulan data dan pemeriksaan fisik didapatkan 10 diagnosis keperawatan. Pemberian asuhan keperawatanpun dilakukan kepada 30 pasien sebagai kasus resume, diperoleh perilaku maladaptif pada mode fisiologis dengan diagnose terbanyak yaitu resiko infeksi dan nyeri kronik. Evidence Based Nursing dengan melakukan foot exercises kepada 8 pasien yang mengalami ulkus kaki diabetik dengan hasil yang signifikan terhadap perubahan ukuran luka. Program inovasi menerapkan Hypoglycemia-Nursing Early Warning Score System pada pasien diabetes melitus tipe 2 yang terbukti memudahkan perawat menilai resiko kejadian hipoglikemi berat selama 1 tahun. Pendekatan Model Adaptasi Roy berpengaruh besar terhadap profesi keperawatan. Model ini menjadi salah satu yang banyak digunakan dalam penelitian, pendidikan dan pelayanan keperawatan.

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Surgical Medical Specialist Nurses play an important role in nursing practice as a provider of advanced nursing care, conduct scientific analysis and scientific evidence and as a reforming agent. Through of this paper we describe the provision of nursing care to patients with a diagnosis of Chronic Limb Threatening Ischemia. The purpose of this paper is to provide an overview of the nursing practice of Surgical Medical Specialists using Roy's Adaptation Model approach. From the results of data collection and physical examination obtained 10 nursing diagnoses. In nursing care was provided to 30 patients as a case of resume, obtained maladaptive behavior in physiological mode with the most diagnoses, the risk of infection and chronic pain. Evidence Based Nursing by performing foot exercises on 8 patients who suffered diabetic foot ulcers with significant results on changes in wound size. The innovative program implementated the Hypoglycemia-Nursing Early Warning Score System in patients with type 2 diabetes mellitus which was proven to make it easier for nurses to assess the risk of severe hypoglycemic events for 1 year. Roy's Adaptation Model approach greatly influencing the nursing profession. This model is one that was widely used in research, education and nursing services"