Ryu Yang Gi, Lee Dong Kyu, Baek Man-Jong, Kim Heezoo
Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
Department of Anesthesia and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
Ann Vasc Surg. 2016 Aug;35:53-9. doi: 10.1016/j.avsg.2016.02.018. Epub 2016 Jun 3.
The intraoperative assessment of autogenous arteriovenous fistulas (AVF) is crucial for achieving an optimal surgical outcome; however, it is not easy to predict the adequacy of surgically created AVF. We used the transit-time flow measurement (TTFM) method to assess the anastomotic quality of AVF and to identify the cutoff value for predicting prognosis of established AVF.
Retrospective study, a total of 187 patients were included in this study. History of diabetes mellitus, hypertension, preoperative vein size, blood pressure, and other demographic data were collected. Surgery for creating radiocephalic AVF was performed by one surgeon, and intraoperative TTFM was performed. Flow parameters were recorded, including the maximal, mean, and minimal flow, and the pulsatility index (PI). Only mean flow ≤70 mL/min regarded as failure. We reviewed patients' follow-up, and we defined "successful AVF" when the patients who managed hemodialysis using established AVF without clinical problems during follow-up.
All patients had a successful operation with adequate mean flow. The established mean flow from the radial artery to the cephalic vein was 199.8 ± 92.7 mL/min, and the PI was 0.57 ± 0.16. None of the patients had any complication during the immediate postoperative period, including infection. Mean follow-up period were 72.4 ± 42.7 weeks. Hemodialysis was maintained in 77.5% of the patients by using the established AVF, and the time to first hemodialysis with the established AVF after surgery was 61.0 ± 22.7 days. Correlation analysis revealed that the time to first hemodialysis was related with mean flow (P = 0.049) and PI (P = 0.009) and successful AVF was related only with PI (P = 0.028). According to curve fit and regression analysis, PI for 95% limit of successful AVF was from 0.43 to 0.77.
Intraoperative TTFM is valuable for the assessment of the quality of established AVFs. Especially PI was correlated successful hemodialysis management for over 12 months, the recommended acceptable range was 0.43-0.77.
自体动静脉内瘘（AVF）的术中评估对于实现最佳手术效果至关重要；然而，预测手术创建的AVF是否充足并不容易。我们使用渡越时间血流测量（TTFM）方法来评估AVF的吻合质量，并确定预测已建立AVF预后的临界值。
回顾性研究，本研究共纳入187例患者。收集糖尿病史、高血压史、术前静脉大小、血压及其他人口统计学数据。由一名外科医生进行头静脉桡动脉AVF创建手术，并进行术中TTFM。记录血流参数，包括最大、平均和最小血流量以及搏动指数（PI）。仅将平均血流量≤70 mL/min视为失败。我们回顾了患者的随访情况，当使用已建立的AVF进行血液透析的患者在随访期间没有临床问题时，我们将其定义为“成功的AVF”。
所有患者手术均成功，平均血流量充足。从桡动脉到头静脉的既定平均血流量为199.8±92.7 mL/min，PI为0.57±0.16。术后即刻所有患者均无任何并发症，包括感染。平均随访期为72.4±42.7周。77.5%的患者通过使用已建立的AVF维持血液透析，术后首次使用已建立的AVF进行血液透析的时间为61.0±22.7天。相关性分析显示，首次血液透析时间与平均血流量（P = 0.049）和PI（P = 0.009）相关，而成功的AVF仅与PI相关（P = 0.028）。根据曲线拟合和回归分析，成功AVF的95%界限的PI为0.43至0.77。
术中TTFM对评估已建立的AVF质量有价值。特别是PI与超过12个月的成功血液透析管理相关，推荐的可接受范围为0.43 - 0.77。
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