Sueki Shina, Sakurada Tsutomu, Miyamoto Masahito, Tsuruoka Kayori, Matsui Katsuomi, Sato Yuichi, Shibagaki Yugo, Kimura Kenjiro
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Hemodial Int. 2014 Oct;18 Suppl 1:S19-22. doi: 10.1111/hdi.12219.
Arteriovenous fistula (AVF) is the most important vascular access method for hemodialysis (HD). However, ischemic steal syndrome occasionally develops. This study evaluated the change in skin perfusion pressure (SPP) after the creation of upper limb AVF and analyzed the relationship between blood flow measurements and the change in SPP. The subjects included 21 patients who underwent radiocephalic AVF creation for the first time between November 2012 and September 2013. We measured SPP on the palm side of the third finger of both hands and assessed blood flow measurements using ultrasound examination before and after the creation of AVF. The subjects consisted of 15 men and 6 women (average age: 65.3 ± 12.7 years, including 12 diabetic patients). Observational period between before and after surgery was 4.9 ± 5.2 days. None of the patients had ischemic steal syndrome after the creation of AVF. Skin perfusion pressure tended to decrease after creation of AVF on the finger of AVF side (100.0 ± 20.9 vs. 87.9 ± 26.5 mmHg, P = 0.063). In contrast, SPP did not change in the limb without AVF (97.9 ± 20.7 vs. 101.0 ± 19.4 mmHg, P = 0.615). The rate of change in SPP was significantly decreased on the finger of AVF side compared with that of limb without AVF (0.055% vs. -0.112%, P = 0.014). There was no correlation between the change in SPP and blood flow measurements. Skin perfusion pressure is possible to detect ischemic steal syndrome after the creation of upper limb AVF.
动静脉内瘘（AVF）是血液透析（HD）最重要的血管通路方式。然而，缺血性窃血综合征偶尔会发生。本研究评估了上肢动静脉内瘘建立后皮肤灌注压（SPP）的变化，并分析了血流测量值与皮肤灌注压变化之间的关系。研究对象包括21例在2012年11月至2013年9月期间首次接受桡动脉-头静脉内瘘建立术的患者。我们测量了双手无名指掌侧的皮肤灌注压，并在动静脉内瘘建立前后使用超声检查评估血流测量值。研究对象包括15名男性和6名女性（平均年龄：65.3±12.7岁，其中包括12例糖尿病患者）。手术前后的观察期为4.9±5.2天。动静脉内瘘建立后，所有患者均未发生缺血性窃血综合征。动静脉内瘘侧手指的皮肤灌注压在动静脉内瘘建立后有下降趋势（100.0±20.9 vs. 87.9±26.5 mmHg，P = 0.063）。相比之下，未建立动静脉内瘘肢体上的皮肤灌注压没有变化（97.9±20.7 vs. 101.0±19.4 mmHg，P = 0.615）。与未建立动静脉内瘘的肢体相比，动静脉内瘘侧手指的皮肤灌注压变化率显著降低（0.055% vs. -0.112%，P = 0.014）。皮肤灌注压变化与血流测量值之间无相关性。上肢动静脉内瘘建立后，皮肤灌注压有可能检测出缺血性窃血综合征。
