Muray Cases Salomé, García Medina José, Pérez Abad Juan Mariano, Andreu Muñoz Alberto Javier, Ramos Carrasco Fernanda, Pérez Pérez Antonio, Lacasa Pérez Noelia, Cabezuelo Romero Juan B
Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España.
Servicio de Radiología Vascular, Hospital General Universitario Reina Sofía, Murcia, España.
Nefrologia. 2016 Jul-Aug;36(4):410-7. doi: 10.1016/j.nefro.2015.10.016. Epub 2016 Mar 2.
The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated.
We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow ≥500ml/min and a cephalic vein diameter of ≥4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study.
In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF.
Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF.
本研究的目的是分析在透析前阶段进行动静脉内瘘 - 桡动脉 - 头静脉转位术（AVF - RC）的结果，在此阶段对其成熟情况进行了临床和影像学随访，并对原发性失败进行了治疗。
我们研究了117例透析前患者的127例桡动脉 - 头静脉转位动静脉内瘘（RC - AVF）。所有病例术前均有血管造影图。如果肱动脉血流量≥500ml/分钟且头静脉直径≥4mm，则认为RC - AVF成熟。根据病变类型，对原发性失败进行放射学或手术治疗。58例患者在研究时开始透析。
在106例未发生血栓形成的RC - AVF中，72例（68%）成熟，34例（32%）不成熟。总共97%的不成熟病例至少有一处病变，最常见的部位是吻合口后静脉。在31%的成熟RC - AVF中发现病变，18%的患者需要治疗。放射学治疗是成熟失败最常用的治疗方法。6个月后，原发性和继发性通畅率分别为59%和78%，而12个月后分别为48%和77%。80%的患者以远端动静脉内瘘开始透析（76%为RC - AVF，4%为尺侧贵要静脉）。接受治疗的不成熟RC - AVF患者中，没有一例以中心静脉导管（CVC）开始透析，而78%的患者以所述动静脉内瘘开始透析。
超声监测成熟情况比临床监测具有优势。通过我们对透析前RC - AVF的管理，80%的患者以合适的远端动静脉内瘘开始透析。
