Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
Nephron Clin Pract. 2013;123(3-4):173-9. doi: 10.1159/000353708. Epub 2013 Aug 6.
Native arteriovenous fistulae (AVF) are the vascular access of choice for haemodialysis. The consequences of AVF formation on microvascular function, locally or systemically, are unknown.
We recruited 43 predialysis patients undergoing AVF formation. Patients were studied 2 weeks prior to the planned AVF operation and 2 weeks postoperatively. Thirteen patients with failed AVF were subsequently utilised as sham controls. Laser Doppler perfusion imaging was used to measure subcutaneous microvascular blood flow. Microvascular function was assessed as an increase in perfusion in response to iontophoretic administration of vasodilatory stimuli assessing endothelial-dependent (ED) and non-endothelial-dependent (NED) vasodilatation.
Patients with successful AVF formation had a significantly reduced ED vasodilatation in the fistula arm (-36 ± 46%, p < 0.001). Only NED vasodilatation was significantly reduced in the non-fistula arm (23 ± 40%, p = 0.01). Patients who had an unsuccessful AVF operation exhibited no recordable changes.
Formation of an AVF was associated with local and remote changes in microcirculation. Further assessments are underway to examine the contributions of local shear stress, vasoreactive substances and the autonomic responses. Although the clinical significance of these findings is not yet clear, it is intriguing that AVF formation is associated with such widespread and profound changes in microperfusion.
原生动静脉瘘（AVF）是血液透析的首选血管通路。AVF 形成对局部或全身微血管功能的影响尚不清楚。
我们招募了 43 名正在接受 AVF 成形术的透析前患者。患者在计划进行 AVF 手术前 2 周和手术后 2 周进行研究。随后，我们利用 13 名 AVF 失败的患者作为假手术对照。使用激光多普勒灌注成像来测量皮下微血管血流。微血管功能评估为通过离子电渗给药刺激来评估内皮依赖性（ED）和非内皮依赖性（NED）血管舒张时灌注的增加。
成功形成 AVF 的患者在瘘管手臂中的 ED 血管舒张明显减少（-36 ± 46%，p < 0.001）。仅在非瘘管手臂中 NED 血管舒张明显减少（23 ± 40%，p = 0.01）。手术不成功的患者则没有记录到可测量的变化。
AVF 的形成与微循环的局部和远程变化有关。进一步的评估正在进行中，以检查局部剪切应力、血管反应物质和自主反应的贡献。尽管这些发现的临床意义尚不清楚，但令人好奇的是，AVF 的形成与如此广泛和深刻的微血管灌注变化有关。
