Mihmanli I, Besirli K, Kurugoglu S, Atakir K, Haider S, Ogut G, Numan F, Canturk E, Sayin A G
Department of Radiology, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.
J Ultrasound Med. 2001 Mar;20(3):217-22. doi: 10.7863/jum.2001.20.3.217.
The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty-four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by chi2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.
本研究的目的是评估术前彩色多普勒超声检查是否能提高透析用动静脉内瘘的即刻成功率。124例慢性肾衰竭患者在动静脉内瘘构建前接受了双臂包括头静脉的彩色多普勒超声检查。患者被随机分为两组：A组和B组。A组有52例患者，外科医生仅根据体格检查计划构建动静脉内瘘。B组有72例患者，外科医生在彩色多普勒超声标记的部位进行动静脉内瘘构建。在A组52例行动静脉内瘘构建手术的患者中，13例内瘘未发挥功能。在这13例患者中，8例在彩色多普勒超声检查时发现头静脉有慢性血栓形成改变，5例没有这些改变。当我们查看彩色多普勒超声检查结果时，注意到这5例患者桡动脉血流减少。总体而言，39例患者（75%）的动静脉内瘘发挥了作用，13例患者（25%）的内瘘未发挥功能。在B组，外科医生遵循彩色多普勒超声检查结果。在72例接受该手术的患者中，68例（94.4%）的内瘘发挥了功能，而4例（5.6%）的内瘘未发挥作用。这4例患者被发现桡动脉血流较低。通过卡方分析比较两组时，差异具有统计学意义（P = 0.002）。术前通过彩色多普勒超声检查进行评估的B组成功率较高。我们发现彩色多普勒超声检查作为一种无创性评估方法非常有帮助。尽管许多外科诊所仍在没有彩色多普勒超声检查结果辅助的情况下进行动静脉内瘘构建，但我们认为在外科医生进行动静脉内瘘构建之前应强调使用彩色多普勒超声检查。
