Lin Chia-Hsun, Chua Chai-Hock, Chiang Shou-Shan, Liou Jer-Young, Hung Huei-Fong, Chang Chung-Hsin
Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
J Vasc Surg. 2008 Jul;48(1):167-72. doi: 10.1016/j.jvs.2008.02.069. Epub 2008 May 23.
Autogenous arteriovenous fistula (AVF) has proven to be the optimal vascular access for the majority of hemodialysis patients due to its durability and low complication rates. The purpose of this study is to determine the value of intraoperative blood flow measurement with respect to AVF short-term outcome.
A prospective cohort study enrolled patients undergoing first time AVF creation surgery for hemodialysis from November 2001 to April 2007. Intraoperative blood flow measurements were collected using transit time flowmeter, and primary and secondary patency rates of AVF were examined. Other variables including age, sex, the presence of diabetes, hypertension, or cerebrovascular disease, current smoking, systolic and diastolic blood pressure, heart rate, serum calcium-phosphate product, and triglyceride and cholesterol level were analyzed.
Autogenous radiocephalic AVFs (n = 109) in 109 patients were constructed and followed up for an average of 21 months. Among these, 54% of patients were 60 years or older, 51% were male, and 56% were diabetics. One-year primary and secondary patency rates for the high-flow group (> or =200 mL/min) were 69% and 94%, respectively. One-year primary and secondary patency rates for the low-flow group (<200 mL/min) was 52% and 80%, respectively. Using hazard analysis, intraoperative blood flow was the most important determinant of primary and secondary patency, in addition to the presence of diabetes.
Intraoperative blood flow measurement is a predictor of the primary and secondary patency of autogenous radiocephalic AVFs. Awareness of the significant correlation between intraoperative AVF blood flow and the short-term outcome would enhance the surgical efficiency and maximize the usefulness of autogenous AVF.
自体动静脉内瘘（AVF）因其耐用性和低并发症发生率，已被证明是大多数血液透析患者的最佳血管通路。本研究的目的是确定术中血流量测量对AVF短期预后的价值。
一项前瞻性队列研究纳入了2001年11月至2007年4月首次接受用于血液透析的AVF创建手术的患者。使用渡越时间流量计收集术中血流量测量值，并检查AVF的初级和次级通畅率。分析了其他变量，包括年龄、性别、糖尿病、高血压或脑血管疾病的存在、当前吸烟情况、收缩压和舒张压、心率、血清钙磷乘积以及甘油三酯和胆固醇水平。
109例患者构建了自体桡动脉头静脉内瘘（n = 109），平均随访21个月。其中，54%的患者年龄在60岁及以上，51%为男性，56%为糖尿病患者。高流量组（≥200 mL/min）的一年初级和次级通畅率分别为69%和94%。低流量组（<200 mL/min）的一年初级和次级通畅率分别为52%和80%。使用风险分析，除糖尿病的存在外，术中血流量是初级和次级通畅的最重要决定因素。
术中血流量测量是自体桡动脉头静脉内瘘初级和次级通畅的预测指标。认识到术中AVF血流量与短期预后之间的显著相关性将提高手术效率，并最大限度地发挥自体AVF的效用。
