Pandey Siddharth, Kumar Manoj, Agrawal Manav, Singh Manmeet, Aggarwal Ajay, Garg Gaurav, Agarwal Samarth, Sankhwar Satyanarayan
Department of Urology, King George's Medical University, Lucknow, India.
Hemodial Int. 2019 Jul;23(3):314-318. doi: 10.1111/hdi.12745. Epub 2019 May 2.
The first choice of vascular access for hemodialysis in patients with end-stage renal disease is a distal radiocephalic arteriovenous fistula (AVF). Early failure rates for these AVFs vary from 10% to 53%. The effects of predialysis hypotension on failure of AVFs have been described in the literature. Weather lower blood pressures affect early AVF failure has not been extensively studied. We conducted this study to evaluate the effects of preoperative blood pressures on early AVF failure.
Ours was a prospective observational study over a period of 2 years that included 224 patients who underwent distal radiocephalic AVF creation. Only those patients were included whose fistulas were made by surgeons with an experience of greater than five cases. The systolic, diastolic, and mean arterial pressures (MAPs) were recorded preoperatively. Early failure was defined as failure to achieve vascular access from the fistula within first 4 months of its creation.
The overall early failure rate was 27.7%. Early failure was more common in females and diabetic patients. The systolic, diastolic, and MAPs were significantly lower in patients with early failure (P < 0.05). In a multivariable adjusted analysis, lower preoperative diastolic and MAPs were predictors for early failure of distal radiocephalic AVF.
Our study shows that patients with early failure of AVFs have lower preoperative blood pressure. A larger study is required to substantiate our findings and define target preoperative blood pressure for AVF creation.
终末期肾病患者血液透析的血管通路首选是远端桡动脉头静脉内瘘（AVF）。这些AVF的早期失败率在10%至53%之间。文献中已描述了透析前低血压对AVF失败的影响。较低的血压是否会影响AVF早期失败尚未得到广泛研究。我们开展这项研究以评估术前血压对AVF早期失败的影响。
我们进行了一项为期2年的前瞻性观察研究，纳入了224例行远端桡动脉头静脉内瘘造瘘术的患者。仅纳入那些由经验超过5例的外科医生制作内瘘的患者。术前记录收缩压、舒张压和平均动脉压（MAP）。早期失败定义为内瘘在创建后的前4个月内未能实现血管通路功能。
总体早期失败率为27.7%。早期失败在女性和糖尿病患者中更为常见。早期失败患者的收缩压、舒张压和MAP显著更低（P < 0.05）。在多变量调整分析中，术前较低的舒张压和MAP是远端桡动脉头静脉内瘘早期失败的预测因素。
我们的研究表明，AVF早期失败的患者术前血压较低。需要开展更大规模的研究来证实我们的发现并确定AVF创建的术前目标血压。
