Pillado Eric, Behdad Mina, Williams Russell, Wilson Samuel E
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Division of Vascular Surgery, Department of Surgery, Irvine School of Medicine, University of California, Irvine, CA; United States Department of Veterans Affairs Long Beach Healthcare System, Long Beach, CA.
Ann Vasc Surg. 2018 May;49:268-272. doi: 10.1016/j.avsg.2018.01.068. Epub 2018 Mar 26.
Construction of radiocephalic arteriovenous fistula (RC-AVF) results in successful hemodialysis (HD) in approximately 40% of end-stage renal disease patients. We investigated whether RC-AVF flow measured by ultrasound 30 days postoperative predicted successful HD.
In this prospective study, color Doppler ultrasound was used to measure cephalic vein outflow volume at 3 forearm sites at 1 and 3 months postoperatively.
Of 45 consecutive patients screened for feasibility of RC-AVF by physical examination and US arterial and vein mapping, 41 were considered suitable for construction of RC-AVF. Mean age was 70 (60-78) years. Of the 41 patients who had a forearm RC-AVF, 25 (61%) proceeded to successful AVF dialysis, 4 (10%) had HD via central venous catheter, and 12 (29%) ceased function within the first 30 days postoperatively. The mean flow at 30 days for patent fistulas was 629 ± 305 ml/min and by the third month had increased to 663 ± 367 mL/min. At 1 month, 8/29 (27.6%) patients had a flow rate <400 mL/min. Two (25%) of these clotted, 2 of 3 with closed revisions went on to HD, and 1 died. Of the 21 patients with a flow rate ≥400 mL/min, 19 (90%) functioned for HD, and 2 (10%) AVF occluded before 1 year, resulting in 17 functioning at 1 year (81% 1-year patency). Sixty-two percent of the low-flow fistulas had successful patency within 1 year.
An RC-AVF flow rate of ≥400 mL/min in the first month predicted more successful HD than low flow (<400 mL/min) (81% vs. 62%). Without intervention, low flow rates do not improve significantly and maturation is unlikely. We recommend imaging for all patients at 30 days to identify and promptly correct stenosis in those with low flow rates.
桡动脉-头静脉内瘘（RC-AVF）构建后，约40%的终末期肾病患者可成功进行血液透析（HD）。我们研究了术后30天通过超声测量的RC-AVF血流量是否能预测HD的成功。
在这项前瞻性研究中，彩色多普勒超声用于测量术后1个月和3个月时3个前臂部位的头静脉流出量。
在45例经体格检查、超声动脉和静脉造影筛查RC-AVF可行性的连续患者中，41例被认为适合构建RC-AVF。平均年龄为70（60 - 78）岁。在41例行前臂RC-AVF的患者中，25例（61%）成功进行了AVF透析，4例（10%）通过中心静脉导管进行HD，12例（29%）在术后30天内功能丧失。通畅内瘘在30天时的平均血流量为629±305 ml/min，到第三个月增加到663±367 ml/min。1个月时，8/29（27.6%）患者的血流量<400 ml/min。其中2例（25%）发生血栓形成，3例经闭合修复中的2例继续进行HD，1例死亡。在21例血流量≥400 ml/min的患者中，19例（90%）功能正常可进行HD，2例（10%）AVF在1年内闭塞，导致17例在1年时功能正常（1年通畅率81%）。62%的低血流量内瘘在1年内成功保持通畅。
第一个月RC-AVF血流量≥400 ml/min比低血流量（<400 ml/min）预测HD更成功（81%对62%）。未经干预，低血流量不会显著改善，且不太可能成熟。我们建议对所有患者在30天时进行成像检查，以识别并及时纠正低血流量患者的狭窄。
