Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Eur J Vasc Endovasc Surg. 2020 Feb;59(2):277-287. doi: 10.1016/j.ejvs.2019.10.010. Epub 2020 Jan 3.
The aim of the study was to observe the natural haemodynamic changes after arteriovenous fistula (AVF) creation in haemodialysis patients with and without a previous ipsilateral vascular access.
This was a retrospective, single centre cohort study. Patient demographics were registered and pre- and post-operative vessel ultrasound examinations were performed at regular follow up intervals. Arteriovenous fistula outcomes in terms of vessel diameter and access flow enhancement were determined for radiocephalic, brachiocephalic, and brachiobasilic AVFs.
In total, 331 patients (median age 66 years, 60% male) with 366 new autologous AVFs were studied, of whom 112 patients had a previous ipsilateral vascular access (VA). Patients with a previous ipsilateral VA had a statistically significantly greater pre-operative brachial artery diameter (4.4 mm) and flow (106 mL/min), and basilic vein diameter (4.9 mm), compared with patients without a previous ipsilateral VA (4.0 mm, 54 mL/min, and 4.3 mm, respectively). For all AVF configurations these differences gradually disappeared over three months after AVF creation. The haemodynamic changes reached a plateau at three months, and were statistically significantly accelerated in patients with a previous ipsilateral VA. There were no differences in primary failure or high flow complications between both groups.
Arteriovenous fistulae show haemodynamic and remodelling changes up to three months post-operatively. Previous ipsilateral VAs may initiate vessel preconditioning, and accelerate the observed haemodynamic changes after AVF creation. However, this preconditioning does not result in a beneficial or detrimental effect on VA function.
本研究旨在观察有和无同侧既往血管通路的血液透析患者动静脉瘘（AVF）术后自然血流动力学变化。
这是一项回顾性、单中心队列研究。记录患者人口统计学数据，并在定期随访时进行术前和术后血管超声检查。桡动脉-头静脉、肱动脉-头静脉和肱动脉-贵要静脉 AVF 的血管直径和血管通路流量增强确定 AVF 结果。
共研究了 331 例（中位年龄 66 岁，60%为男性）患者的 366 例新自体 AVF，其中 112 例患者有同侧既往血管通路（VA）。与无同侧既往 VA 的患者相比，有同侧既往 VA 的患者术前肱动脉直径（4.4mm）和流量（106mL/min）以及贵要静脉直径（4.9mm）均显著增大。对于所有 AVF 构型，这些差异在 AVF 建立后三个月逐渐消失。血流动力学变化在三个月时达到平台期，且在有同侧既往 VA 的患者中呈统计学显著加速。两组之间在原发性失败或高流量并发症方面无差异。
动静脉瘘术后 3 个月内出现血流动力学和重塑变化。同侧既往 VA 可能启动血管预处理，并加速 AVF 建立后观察到的血流动力学变化。然而，这种预处理不会对 VA 功能产生有益或有害的影响。
