Coskun Isa, Colkesen Yucel, Altay Hakan, Ozkan Ugur, Demirturk O Saim, Gulcan Oner, Guvener Murat
Department of Cardiovascular Surgery, Baskent University Faculty of Medicine, Adana, Turkey.
Thorac Cardiovasc Surg. 2013 Dec;61(8):663-7. doi: 10.1055/s-0032-1331464. Epub 2013 Jan 23.
Arteriovenous fistula (AVF) in patients undergoing hemodialysis (HD) may cause coronary left internal mammary artery (IMA) steal. This phenomenon was demonstrated by few prospective studies with limited number of patients and case reports. We aimed to demonstrate with a relatively larger patient population that the AVF may cause ipsilateral IMA steal.
We included 22 prospective patients undergoing HD who had left IMA to left anterior descending artery graft and left upper limb AVF. Right IMA was taken as control. Flows were assessed by using color Doppler ultrasonography.
The mean age was 57.8 ± 9 years. Statistically nonsignificant increases in AVF flow and decreases in left IMA flow were observed during HD compared with pre-HD. Moreover, fistula localization did not affect median left IMA flows (for peak systolic velocity [PSV] 43.7 versus 70 cm/s, respectively; p = 0.7, and for end diastolic velocity [EDV] 3.4 versus 6.5 cm/s, respectively; p = 0.7). We have not detected significant difference in left IMA flows during HD (median values of PSV 58.4 versus 68.4 cm/s, respectively; p = 0.1, and EDV 6.4 versus 4.4 cm/s, respectively; p = 0.08). Only three patients experienced dialysis-induced reduction of ipsilateral IMA flow that was accompanied by evidence of hypokinesia of the anterior left ventricular wall without clinical angina.
Hemodynamically affected left IMA flow by ipsilateral upper extremity AVF may cause steal phenomenon. Hemodynamic differences between left and right IMAs in patients undergoing HD via left wrist and brachial fistulae are limited.
接受血液透析（HD）的患者发生动静脉内瘘（AVF）可能导致左乳内动脉（IMA）窃血。这一现象仅有少数患者数量有限的前瞻性研究及病例报告予以证实。我们旨在纳入相对更多的患者群体来证实AVF可能导致同侧IMA窃血。
我们纳入了22例接受HD的前瞻性患者，这些患者有左IMA至左前降支动脉搭桥术及左上肢AVF。将右IMA作为对照。使用彩色多普勒超声评估血流情况。
平均年龄为57.8±9岁。与HD前相比，HD期间观察到AVF血流量有统计学意义的非显著性增加，左IMA血流量有统计学意义的非显著性减少。此外，内瘘位置并不影响左IMA血流中位数（收缩期峰值流速[PSV]分别为43.7与70 cm/s；p = 0.7，舒张末期流速[EDV]分别为3.4与6.5 cm/s；p = 0.7）。我们未检测到HD期间左IMA血流有显著差异（PSV中位数分别为58.4与68.4 cm/s；p = 0.1，EDV中位数分别为6.4与4.4 cm/s；p = 0.08）。仅3例患者出现透析诱导的同侧IMA血流减少，伴有左心室前壁运动减弱的证据，但无临床心绞痛症状。
同侧上肢AVF对左IMA血流产生的血流动力学影响可能导致窃血现象。通过左手腕和肱动脉内瘘进行HD的患者，左右IMA之间的血流动力学差异有限。
