Hou Guocun, Yan Yonghong, Li Guangyi, Hou Yi, Sun Xiuli, Yin Na, Feng Guozhen
Department of Nephrology, Baotou Central Hospital, Baotou, China.
Department of Radiology, Baotou Central Hospital, Baotou, China.
J Vasc Access. 2020 May;21(3):366-371. doi: 10.1177/1129729819879320. Epub 2019 Oct 3.
To identify predictors that affect initial maturation of new wrist radio-cephalic arteriovenous fistula and evaluate the clinical effects of the ipsilateral mid-forearm radio-cephalic arteriovenous fistulas creation in the event of first wrist radio-cephalic arteriovenous fistula failure.
We performed a retrospective review of all patients who underwent first wrist radio-cephalic arteriovenous fistula creation between September 2016 and May 2018. Currently, we prefer to re-create an ipsilateral mid-forearm radio-cephalic arteriovenous fistula when the first wrist radio-cephalic arteriovenous fistula fails. Predictors of successful radio-cephalic arteriovenous fistulas were identified using univariate and multivariate analyses. Kaplan-Meier survival analysis and log-rank test were used to calculate successful radio-cephalic arteriovenous fistula rates.
Univariate analysis showed that predictive factors for successful wrist radio-cephalic arteriovenous fistula include larger preoperative cephalic vein diameter ( = 0.001) and non-diabetic kidney disease ( = 0.007). Multivariate binary logistic regression analysis revealed cephalic vein diameter ⩾2 mm (odds ratio = 4.55, 95% confidence interval = (1.49-13.92), = 0.008) and non-diabetic kidney disease (odds ratio = 4.22, 95% confidence interval = (1.38-12.88), = 0.011) to be independent predictors for successful radio-cephalic arteriovenous fistula. We re-created ipsilateral mid-forearm radio-cephalic arteriovenous fistulas in 15 patients among the 21 failed wrist radio-cephalic arteriovenous fistulas; all these arteriovenous fistulas maintained clinical maturation following up for 1-2 years.
Small cephalic vein diameter (<2 mm) and diabetes were independent risk factors for failed wrist radio-cephalic arteriovenous fistulas, but this risk could be overcome by aggressive ipsilateral mid-forearm radio-cephalic arteriovenous fistula to address a failed first attempt. Cephalic vein diameter is more important during the maturation stage, and once maturation has occurred, diabetes has an additive role in determining the patency of wrist radio-cephalic arteriovenous fistula. The "wrist RCAVF first, ipsilateral mid-forearm RCAVF second" strategy is the most clinically significant message of our study.
确定影响新型腕部桡动脉-头静脉内瘘初始成熟的预测因素，并评估在首次腕部桡动脉-头静脉内瘘失败时，同侧前臂中段桡动脉-头静脉内瘘成形术的临床效果。
我们对2016年9月至2018年5月期间接受首次腕部桡动脉-头静脉内瘘成形术的所有患者进行了回顾性研究。目前，当首次腕部桡动脉-头静脉内瘘失败时，我们更倾向于重新建立同侧前臂中段桡动脉-头静脉内瘘。使用单因素和多因素分析确定桡动脉-头静脉内瘘成功的预测因素。采用Kaplan-Meier生存分析和对数秩检验计算桡动脉-头静脉内瘘成功的发生率。
单因素分析显示，腕部桡动脉-头静脉内瘘成功的预测因素包括术前头静脉直径较大（=0.001）和非糖尿病肾病（=0.007）。多因素二元逻辑回归分析显示，头静脉直径≥2mm（比值比=4.55，95%置信区间=(1.49 - 13.92)，=0.008）和非糖尿病肾病（比值比=4.22，95%置信区间=(1.38 - 12.88)，=0.011）是桡动脉-头静脉内瘘成功的独立预测因素。在21例失败的腕部桡动脉-头静脉内瘘患者中，我们为15例患者重新建立了同侧前臂中段桡动脉-头静脉内瘘；所有这些内瘘在随访1 - 2年后均保持临床成熟。
头静脉直径小（<2mm）和糖尿病是腕部桡动脉-头静脉内瘘失败的独立危险因素，但通过积极采用同侧前臂中段桡动脉-头静脉内瘘来处理首次尝试失败的情况，可以克服这种风险。在成熟阶段，头静脉直径更为重要，一旦成熟发生，糖尿病在决定腕部桡动脉-头静脉内瘘的通畅性方面具有累加作用。“先进行腕部桡动脉-头静脉内瘘，其次是同侧前臂中段桡动脉-头静脉内瘘”的策略是我们研究中最具临床意义的信息。
