Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
J Vasc Surg. 2019 Feb;69(2):526-531. doi: 10.1016/j.jvs.2018.05.217. Epub 2018 Oct 9.
We aimed to compare routine preoperative color-coded duplex ultrasound (DUS) to clinical examination (CE) alone in surgery for arteriovenous fistula (AVF) with special emphasis on long-term outcomes and cost effectiveness.
All patients undergoing an AVF formation or revision between January 1, 2011, and December 31, 2016, at our tertiary referral center were subject to analysis. Routine DUS was performed in 114 patients and CE alone in 217 patients. Primary and secondary patency, the need for revision or reintervention to obtain patency, and individual as well as overall costs were analyzed.
Primary patency rate was higher in AVF after DUS compared with CE alone at 62% vs 26% (P < .05), respectively. Patients receiving DUS had significantly lower rates of revision and revisions per patient when compared with CE (25.4% vs 59.4% [P < .0001]; 0.36 ± 0.71 vs 1.06 ± 1.55 [P < .0001], respectively). Costs per patient were significantly lower in the DUS group compared with CE at 4074€ vs 6078€ (P < .0001).
We were able to show that patients receiving preoperative DUS showed higher patency rates and needed fewer revisions. Standard preoperative ultrasound examination is an easy tool to improve outcomes and cost effectiveness in AVF surgery.
我们旨在比较彩色双功能超声（DUS）常规术前检查与单纯临床检查（CE）在动静脉瘘（AVF）手术中的应用，特别强调长期结果和成本效益。
对 2011 年 1 月 1 日至 2016 年 12 月 31 日期间在我们的三级转诊中心接受 AVF 成形术或修复术的所有患者进行分析。114 例患者进行常规 DUS，217 例患者进行单纯 CE。分析主要和次要通畅率、获得通畅性所需的修订或再干预的必要性以及个体和总体成本。
与单纯 CE 相比，DUS 后 AVF 的主要通畅率更高，分别为 62%和 26%（P<.05）。与 CE 相比，接受 DUS 的患者的修订率和每个患者的修订次数明显较低（25.4%对 59.4%[P<.0001]；0.36±0.71 对 1.06±1.55[P<.0001]）。与 CE 相比，DUS 组每个患者的成本明显较低，分别为 4074 欧元对 6078 欧元（P<.0001）。
我们能够表明，接受术前 DUS 的患者通畅率更高，需要的修订更少。标准的术前超声检查是一种提高 AVF 手术效果和成本效益的简单工具。
