Beigi Ali Akbar, Sadeghi Amir Mir Mohammad, Khosravi Ali Reza, Karami Mehdi, Masoudpour Hassan
Vascular Surgery Department, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran.
J Vasc Access. 2009 Jul-Sep;10(3):160-6. doi: 10.1177/112972980901000305.
Access to the vascular system is necessary in patients with chronic renal failure planned to undergo dialysis. One of the complications of end-stage renal disease patients is pulmonary hypertension (PHT). Temporary arteriovenous access closure and successful kidney transplantation causes a significant fall in cardiac output and pulmonary artery pressure (PAP), indicating the possibility that excessive pulmonary blood flow is involved in the pathogenesis of the disease. We attempted to study the relationship of PHT with arteriovenous fistula (AVF) creation, as well as to assess the relationship between AVF flow and fistula characteristics.
Fifty patients were included in the study. Echocardiography was used to evaluate systolic PAP, cardiac output (CO), and ejection fraction (EF) before creating the AVF. After a follow-up interval of at least 6 months, a second echocardiographic assessment and a Doppler sonographic assessment of their fistula flow were carried out. Complete data were available for 34 patients.
Study data were collected from 34 patients, 28 males and 6 females with a mean age of 52 yrs ranging from 15-78 yrs. The data showed a statistically significant positive correlation between fistula flow and PAP2 and PAP changes (p <0.05). Mean fistula flow was 1322 ml/min in patients without PHT and 2750 ml/min in patients with PHT. This difference (1428 ml/min) was statistically significant (p=0.03). We found a significant negative correlation between PAP1 and EF1 and PAP2 and EF2 (p <0.05). In addition, the mean EF2 in patients without PHT was 57% in contrast to 46% in patients with PHT. Mean fistula flow in radial fistulae (mean=422 ml/min, range: 370-474 ml/min) was significantly less than brachial fistulae (mean=1463 ml, range: 270-3300 ml/min) (p=0.03). Mean systolic PAP2 of 14.8 mmHg in transplanted patients was 5.9 mmHg less than those who were not transplanted (20.7 mmHg). Diabetes was the most common cause of renal failure and diabetics had a significant reduction in their EF (15.5%) compared with non-diabetic patients (1% reduction) (p=0.016).
Fistula flow, PAP and EF of all patients should be checked at least 6 months after fistula creation. Patients with higher fistula flow rates and patients with diabetes mellitus need to be more closely observed. In addition, elderly patients with significant cardiac and other comorbidities may be more prone to develop symptoms after AVF creation.
对于计划接受透析的慢性肾衰竭患者，建立血管通路很有必要。终末期肾病患者的并发症之一是肺动脉高压（PHT）。临时性动静脉通路关闭及成功的肾移植会导致心输出量和肺动脉压（PAP）显著下降，这表明过多的肺血流量可能参与了该疾病的发病机制。我们试图研究PHT与动静脉内瘘（AVF）建立之间的关系，并评估AVF血流量与内瘘特征之间的关系。
本研究纳入50例患者。在建立AVF之前，使用超声心动图评估收缩期PAP、心输出量（CO）和射血分数（EF）。经过至少6个月的随访期后，进行第二次超声心动图评估以及对其内瘘血流量进行多普勒超声评估。34例患者获得了完整数据。
研究数据收集自34例患者，其中男性28例，女性6例，平均年龄52岁，年龄范围为15 - 78岁。数据显示，内瘘血流量与PAP2及PAP变化之间存在统计学上显著的正相关（p<0.05）。无PHT患者的平均内瘘血流量为1322 ml/min，有PHT患者为2750 ml/min。这一差异（1428 ml/min）具有统计学意义（p = 0.03）。我们发现PAP1与EF1以及PAP2与EF2之间存在显著的负相关（p<0.05）。此外，无PHT患者的平均EF2为57%，而有PHT患者为46%。桡动脉内瘘的平均血流量（平均 = 422 ml/min，范围：370 - 474 ml/min）显著低于肱动脉内瘘（平均 = 1463 ml，范围：270 - 3300 ml/min）（p = 0.03）。移植患者的平均收缩期PAP2为14.8 mmHg，比未移植患者（20.7 mmHg）低5.9 mmHg。糖尿病是肾衰竭最常见的原因，与非糖尿病患者相比，糖尿病患者的EF显著降低（降低15.5%），而非糖尿病患者降低1%（p = 0.016）。
在建立内瘘后至少6个月，应检查所有患者的内瘘血流量、PAP和EF。内瘘血流量较高的患者和糖尿病患者需要更密切地观察。此外，患有严重心脏疾病及其他合并症的老年患者在建立AVF后可能更容易出现症状。
