Sivanesan S, How T V, Bakran A
Royal Liverpool University Hospital and Department of Clinical Engineering, University of Liverpool, UK.
Nephrol Dial Transplant. 1999 Jan;14(1):118-20. doi: 10.1093/ndt/14.1.118.
A large proportion of late failures of radiocephalic arteriovenous fistulae are related to the progression of intimal hyperplasia. The aetiology of this process is still unknown but the fistula configuration and resultant haemodynamics have been implicated. This clinical study was devised to identify sites of stenosis in patients with fistulae and relate the findings to various clinical and geometrical parameters.
Measurement of anastomotic length and angle was made intraoperatively in 25 consecutive fistulae. Post-operative assessment was carried out at regular intervals using duplex and colour-flow ultrasonography.
Stenoses were present in all 25 of the fistulae studied at 3 months. The stenoses could be classified to three specific sites: at the anastomosis (Type 1), on the inner wall of the curved region of the cephalic vein (Type 2) and just proximal to this curved segment where the vein straightens out (Type 3). Most of Type 1 and Type 2 stenoses were not progressive while Type 3 stenoses were generally progressive.
These findings emphasize the need for an effective surveillance programme of AV fistulae.
桡动脉-头静脉动静脉内瘘的晚期失败很大一部分与内膜增生的进展有关。这一过程的病因尚不清楚，但内瘘的形态及由此产生的血流动力学已被认为与之相关。本临床研究旨在确定内瘘患者的狭窄部位，并将研究结果与各种临床和几何参数相关联。
对连续25例动静脉内瘘患者在术中测量吻合口长度和角度。术后定期使用双功超声和彩色血流超声进行评估。
在研究的所有25例动静脉内瘘中，术后三个月均出现狭窄。狭窄可分为三个特定部位：吻合口处（1型）、头静脉弯曲区域内壁（2型）以及该弯曲段近端静脉变直处（3型）。大多数1型和2型狭窄不会进展，而3型狭窄通常会进展。
这些发现强调了对动静脉内瘘进行有效监测计划的必要性。
