Allon Michael, Robbin Michelle L, Umphrey Heidi R, Young Carlton J, Deierhoi Mark H, Goodman Jeremy, Hanaway Michael, Lockhart Mark E, Barker-Finkel Jill, Litovsky Silvio
Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
Am J Kidney Dis. 2015 Jul;66(1):84-90. doi: 10.1053/j.ajkd.2014.12.015. Epub 2015 Feb 18.
Arteriovenous fistulas (AVFs) often fail to mature, but the mechanism of AVF nonmaturation is poorly understood. Arterial microcalcification is common in patients with chronic kidney disease (CKD) and may limit vascular dilatation, thereby contributing to early postoperative juxta-anastomotic AVF stenosis and impaired AVF maturation. This study evaluated whether preexisting arterial microcalcification adversely affects AVF outcomes.
Prospective study.
SETTING & PARTICIPANTS: 127 patients with CKD undergoing AVF surgery at a large academic medical center.
Preexisting arterial microcalcification (≥1% of media area) assessed independently by von Kossa stains of arterial specimens obtained during AVF surgery and by preoperative ultrasound.
Juxta-anastomotic AVF stenosis (ascertained by ultrasound obtained 4-6 weeks postoperatively), AVF nonmaturation (inability to cannulate with 2 needles with dialysis blood flow ≥ 300mL/min for ≥6 sessions in 1 month within 6 months of AVF creation), and duration of primary unassisted AVF survival after successful use (time to first intervention).
Arterial microcalcification was present by histologic evaluation in 40% of patients undergoing AVF surgery. The frequency of a postoperative juxta-anastomotic AVF stenosis was similar in patients with or without preexisting arterial microcalcification (32% vs 42%; OR, 0.65; 95% CI, 0.28-1.52; P=0.3). AVF nonmaturation was observed in 29%, 33%, 33%, and 33% of patients with <1%, 1% to 4.9%, 5% to 9.9%, and ≥10% arterial microcalcification, respectively (P=0.9). Sonographic arterial microcalcification was found in 39% of patients and was associated with histologic calcification (P=0.001), but did not predict AVF nonmaturation. Finally, among AVFs that matured, unassisted AVF maturation (time to first intervention) was similar for patients with and without preexisting arterial microcalcification (HR, 0.64; 95% CI, 0.35-1.21; P=0.2).
Single-center study.
Arterial microcalcification is common in patients with advanced CKD, but does not explain postoperative AVF stenosis, AVF nonmaturation, or AVF failure after successful cannulation.
动静脉内瘘（AVF）常无法成熟，但其未成熟机制尚不清楚。动脉微钙化在慢性肾脏病（CKD）患者中很常见，可能会限制血管扩张，从而导致术后早期吻合口旁AVF狭窄和AVF成熟受损。本研究评估了预先存在的动脉微钙化是否会对AVF的预后产生不利影响。
前瞻性研究。
127例在大型学术医学中心接受AVF手术的CKD患者。
通过AVF手术期间获取的动脉标本的冯·科萨染色和术前超声独立评估预先存在的动脉微钙化（≥中膜面积的1%）。
吻合口旁AVF狭窄（通过术后4 - 6周的超声确定）、AVF未成熟（在AVF建立后6个月内1个月内无法用2根针进行透析血流量≥300mL/min的穿刺≥6次）以及成功使用后初次无辅助AVF存活的持续时间（首次干预时间）。
组织学评估显示，40%接受AVF手术的患者存在动脉微钙化。有或无预先存在动脉微钙化的患者术后吻合口旁AVF狭窄的发生率相似（32%对42%；OR，0.65；95%CI，0.28 - 1.52；P = 0.3）。动脉微钙化<1%、1%至4.9%、5%至9.9%和≥10%的患者中，AVF未成熟的发生率分别为29%、33%、33%和33%（P = 0.9）。39%的患者发现超声动脉微钙化，且与组织学钙化相关（P = 0.001），但不能预测AVF未成熟。最后，在成熟的AVF中，有或无预先存在动脉微钙化的患者无辅助AVF成熟（首次干预时间）相似（HR，0.64；95%CI，0.35 - 1.21；P = 0.2）。
单中心研究。
动脉微钙化在晚期CKD患者中很常见，但不能解释术后AVF狭窄、AVF未成熟或成功穿刺后AVF失败。
