Blessios George, Hlepas Alexander, Diaz Alonso
Dialysis Access Center (DAC), Mercy Hospital of Buffalo, Buffalo, NY, USA.
University of Illinois at Chicago, Chicago, IL, USA.
J Vasc Access. 2020 Jul;21(4):434-439. doi: 10.1177/1129729819881605. Epub 2019 Oct 23.
Preoperative Doppler ultrasound evaluation of arteriovenous fistula inflow artery includes measurements of arterial diameter and flow volume. The purpose of this study was to evaluate the significance of flow volume to arteriovenous fistula maturation rate.
Review of consecutive patients who underwent arteriovenous fistula creation by a single surgeon. Cases with available preoperative arterial diameter and flow volume were analyzed. Primary end point was arteriovenous fistula failure to mature. Information collected included demographics, Doppler ultrasound reports, level of inflow artery, operative reports, and outcomes to the time of arteriovenous fistula maturation or failure. Risk factors were identified by logistic regression analysis. Outcomes were compared by odds ratio.
Four hundred and three cases were identified. Arterial diameter and flow volume were both independent significant risk factors affecting arteriovenous fistula maturation rate (p = 0.001). Arterial diameter of <2.5 mm and flow volume of <20 mL/min predicted failure to mature with 95% specificity. Further comparison of cases with optimal arterial diameter but flow volume of <20 mL/min showed increased failure to mature rate compared to the combination of optimal arterial diameter with optimal flow volume (p = 0.01).
Preoperative arterial diameter and flow volume values were both significant independent variables affecting arteriovenous fistula maturation rate. However, flow volume of <20 mL/min remained a significant risk factor to failure-to-mature rate, despite optimal arterial diameter.
动静脉内瘘流入动脉的术前多普勒超声评估包括动脉直径和血流量的测量。本研究的目的是评估血流量对动静脉内瘘成熟率的意义。
回顾由单一外科医生进行动静脉内瘘创建的连续患者。分析术前有可用动脉直径和血流量的病例。主要终点是动静脉内瘘未成熟。收集的信息包括人口统计学资料、多普勒超声报告、流入动脉水平、手术报告以及动静脉内瘘成熟或失败时的结果。通过逻辑回归分析确定危险因素。通过比值比比较结果。
共纳入403例病例。动脉直径和血流量均为影响动静脉内瘘成熟率的独立显著危险因素（p = 0.001）。动脉直径<2.5 mm和血流量<20 mL/min预测未成熟的特异性为95%。进一步比较动脉直径最佳但血流量<20 mL/min的病例与动脉直径最佳且血流量最佳的病例组合，发现未成熟率增加（p = 0.01）。
术前动脉直径和血流量值均为影响动静脉内瘘成熟率的显著独立变量。然而，尽管动脉直径最佳，但血流量<20 mL/min仍然是未成熟率的显著危险因素。
