Chai Siew Cheng, Sulaiman Wan Azman Wan, Saad Arman Zaharil Mat, Rasool Aida Hanum, Shokri Amran Ahmed
Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia.
Indian J Nephrol. 2018 Nov-Dec;28(6):421-426. doi: 10.4103/ijn.IJN_402_17.
Maturation of arteriovenous fistula (AVF) involves complex vascular remodeling. In this study, we evaluated the changes of skin microvascular perfusion over the extremity with AVF maturation using the laser Doppler fluximetry (LDF). A total of 45 patients with chronic kidney disease, Stages IV-V, were included; they had undergone AVF creation from July 2014 to June 2016 at our institute. The measurement of skin microvascular perfusion was accomplished proximal and distal to the fistula anastomosis site: pre- and post-operative day 1, week 2, week 6, and week 12. Thirty-two patients with mean age of 55.6 had achieved AVF maturation. There were 40.6% radial-based and 59.4% brachial-based AVF. There was a 32.8% reduction of mean skin perfusion distal to the fistula by day 1 compared to the baseline perfusion; however, perfusion increased 47% by week 2 compared to day 1 and no dramatic change was subsequently noted. There was an increase of mean skin perfusion, proximal to fistula anastomosis, over 12 weeks with 35.8% at day 1 from the baseline. However, the changes of the mean skin perfusion were not statistically significant. There was no significant relation of skin perfusion changes with the type of fistula, diabetes mellitus, hypertension, and hyperlipidemia. LDF successfully detected the subclinical change of skin microvascular perfusion in relation to AVF creation. Reduction of skin perfusion distal to the fistula suggests that in patients with existing perfusion inadequacy of extremities, they may experience ischemic symptoms as early as day 1 postoperation, and require close monitoring for distal limb ischemic-related complications.
动静脉内瘘（AVF）的成熟涉及复杂的血管重塑。在本研究中，我们使用激光多普勒血流仪（LDF）评估了随着AVF成熟，肢体皮肤微血管灌注的变化。总共纳入了45例慢性肾脏病IV - V期患者；他们于2014年7月至2016年6月在我院接受了AVF造瘘术。在瘘管吻合部位的近端和远端进行皮肤微血管灌注测量：术前、术后第1天、第2周、第6周和第12周。32例平均年龄为55.6岁的患者实现了AVF成熟。以桡动脉为基础的AVF占40.6%，以肱动脉为基础的AVF占59.4%。与基线灌注相比，术后第1天瘘管远端的平均皮肤灌注降低了32.8%；然而，与第1天相比，第2周时灌注增加了47%，随后未观察到显著变化。在12周内，瘘管吻合近端的平均皮肤灌注增加，术后第1天相对于基线增加了35.8%。然而，平均皮肤灌注的变化无统计学意义。皮肤灌注变化与瘘管类型、糖尿病、高血压和高脂血症之间无显著关系。LDF成功检测到了与AVF造瘘相关的皮肤微血管灌注的亚临床变化。瘘管远端皮肤灌注的降低表明，对于现有肢体灌注不足的患者，他们可能在术后第1天就出现缺血症状，需要密切监测远端肢体缺血相关并发症。
