多普勒超声在明确及临界狭窄定义中的作用。

The Role of Doppler Ultrassonography in Significant and Borderline Stenosis Definition.

机构信息

Grupo de Estudos Vasculares, Porto, Portugal.

Centro de Acessos Vasculares Nephrocare Gaia, Porto, Portugal.

出版信息

Blood Purif. 2018;46(2):94-102. doi: 10.1159/000488442. Epub 2018 Apr 19.

DOI:10.1159/000488442

PMID:29672304

Abstract

BACKGROUND

The definition of significant stenosis (SS) remains controversial.

METHODS

We retrospectively reviewed 1,040 consultations. SS was defined in the presence of clinical and echo-Doppler (DDU) criteria: Qa <500 mL/min or Qa decrease >25%; RI >0.7 in the feeding artery or absolute minimal luminal stenosis diameter <2.0 mm. Stenosis without any additional criteria were considered borderline stenosis (BS).

RESULTS

Two hundred twenty-one arteriovenous fistulas (AVFs) were included: 58.8% had SS, 18.6% had BS, and 22.6% had no dysfunctional access (ND). SS had a significantly higher thrombotic events than BS and ND (13.1 vs. 4.4%, p = 0.018). The annual thrombosis rate was 0.007, 0.037, and 0.004 in the ND, SS, and BS, respectively. AVF cumulative survival at 5 years was significantly lower in SS (89.5%) compared to BS (100%) and ND (97.4%; p = 0.03). BS had an HR for AVF failure of 1.1, p = 0.955, while the SS presented an HR of 5.9, p = 0.09.

CONCLUSION

AVF clinical monitoring with additional DDU criteria appear to be appropriate for therapeutic referral.

摘要

背景

狭窄程度的定义仍存在争议。

方法

我们回顾性分析了 1040 例会诊。狭窄程度定义为存在临床和超声多普勒（DDU）标准：Qa <500 mL/min 或 Qa 下降>25%；供血动脉 RI >0.7 或绝对最小管腔狭窄直径 <2.0 mm。没有其他标准的狭窄程度被认为是临界狭窄（BS）。

结果

221 例动静脉瘘（AVF）中，58.8%存在 SS，18.6%存在 BS，22.6%不存在功能障碍性通路（ND）。SS 的血栓形成事件发生率明显高于 BS 和 ND（13.1%比 4.4%，p = 0.018）。ND、SS 和 BS 的年血栓形成率分别为 0.007、0.037 和 0.004。SS 的 AVF 累积 5 年生存率明显低于 BS（89.5%比 100%和 ND（97.4%；p = 0.03）。BS 的 AVF 失败风险比（HR）为 1.1，p = 0.955，而 SS 的 HR 为 5.9，p = 0.09。