Schwarz Christoph, Mitterbauer Christa, Boczula Maryla, Maca Thomas, Funovics Martin, Heinze Georg, Lorenz Matthias, Kovarik Josef, Oberbauer Rainer
Department of Internal Medicine, Division of Nephrology, University of Vienna, Vienna, Austria.
Am J Kidney Dis. 2003 Sep;42(3):539-45. doi: 10.1016/s0272-6386(03)00786-8.
Measurement of access blood flow is the preferred noninvasive screening test for hemodialysis arteriovenous (AV) fistula stenosis. However, performance characteristics of the 2 most frequently used ultrasound techniques compared with fistulography remain elusive.
We evaluated 59 hemodialysis patients with native forearm AV fistulae who underwent all 3 measurements in a prospective order: the ultrasound dilution technique (UDT), color Doppler ultrasonography (CDUS), and fistulography. Patients with angiographically diagnosed access stenosis underwent angioplasty and were followed up by means of monthly UDT measurements until restenosis occurred within the first 6 months.
Both ultrasound techniques predicted access stenosis (P < 0.01). Performance was similar between both techniques, evaluated by receiver operating characteristic curves. Areas under the curve averaged 0.79 (95% confidence interval [CI], 0.66 to 0.91) for UDT and 0.80 (95% CI, 0.65 to 0.94) for CDUS. Correlation between measured UDT and CDUS blood flow rates was 0.37 (Spearman's rho, rho = 0.004). The calculated optimal cutoff value for the prediction of stenosis was 465 mL/min for the UDT and 390 mL/min for the CDUS technique. Access stenosis was diagnosed in 41 patients who subsequently underwent percutaneous angioplasty (PTA), which was successful in 34 patients. Restenosis occurred in 13 patients within the first 6 months after PTA. UDT access blood flow after PTA was significantly lower in these 13 patients compared with the other 21 patients.
Our data suggest that blood flow monitoring of AV hemodialysis access by ultrasound provides a reasonable prediction of access stenosis and restenosis.
测量通路血流量是血液透析动静脉（AV）内瘘狭窄首选的无创筛查试验。然而，与瘘管造影术相比，两种最常用超声技术的性能特征仍不明确。
我们前瞻性地依次评估了59例接受自体前臂AV内瘘的血液透析患者的三种测量方法：超声稀释技术（UDT）、彩色多普勒超声（CDUS）和瘘管造影术。血管造影诊断为通路狭窄的患者接受血管成形术，并通过每月UDT测量进行随访，直至在最初6个月内发生再狭窄。
两种超声技术均能预测通路狭窄（P<0.01）。通过受试者工作特征曲线评估，两种技术的性能相似。UDT的曲线下面积平均为0.79（95%置信区间[CI]，0.66至0.91），CDUS为0.80（95%CI，0.65至0.94）。测量的UDT和CDUS血流率之间的相关性为0.37（Spearman秩相关系数，ρ=0.004）。预测狭窄的计算最佳截断值，UDT为465 mL/min，CDUS技术为390 mL/min。41例患者诊断为通路狭窄，随后接受经皮血管成形术（PTA），其中34例成功。13例患者在PTA后最初6个月内发生再狭窄。与其他21例患者相比，这13例患者PTA后的UDT通路血流量显著降低。
我们的数据表明，通过超声监测AV血液透析通路血流量可合理预测通路狭窄和再狭窄。
