Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.
J Vasc Access. 2022 Jan;23(1):109-116. doi: 10.1177/1129729820983147. Epub 2020 Dec 22.
The modified Allen test (MAT) is a simple bedside method determining collateral hand circulation prior to hemodialysis (HD) access surgery. Hand ischemia as reflected by low systolic finger pressures () is associated with high mortality rates in severe kidney disease (CKD) patients. Aim of the present study was to assess a possible relation between absolute finger pressure drop (∂) during a preoperative MAT and mortality after a first HD access construction.
(systolic pressure, mmHg) was measured using digital plethysmography following compression of radial and ulnar arteries in CKD patients just before access surgery between January 2009 and December 2018 in one center. The greatest ∂ of both index fingers was used for analysis. Cardiovascular and overall mortality were assessed during the following 4 years using the ERA-EDTA classification system (codes 11, 14-16, 18, 22-26, 29). Cox regression analysis determined possible associations between ∂ and mortality.
Complete data sets were available in 108 patients (male = 71; age 70 years ±12; mean follow up (FU) 1.6 years ±0.1; FU index 99% ±1). Median ∂ was 31 mmHg (range 0-167 mmHg). Patients having cardiovascular disease (CV+) demonstrated higher ∂ values (CV+ 44 ± 5 mmHg vs CV- 29 ± 3 mmHg, = 0.012). A total of 26 patients (24%) died during FU (CV+ death, = 16; 62%). For each 10 mmHg ∂ increase, overall mortality increased by 10%, and CV+ mortality by 15% (overall mortality: HR 1.10 [1.01-1.22], = 0.048; CV+ mortality: 1.15 [1.03-1.29], = 0.017). Following correction for age, ∂ remained associated with CV+ mortality (HR 1.13 [1.00-1.26], = 0.043).
A large drop in systolic finger pressure during a preoperative MAT is related to mortality after primary HD access surgery. The role of this potential novel risk parameter requires confirmation in a larger population.
改良 Allen 试验（MAT）是一种简单的床边方法，用于在血液透析（HD）通路手术前确定侧支手部循环。手部缺血表现为低收缩压手指压（）与严重肾病（CKD）患者的高死亡率相关。本研究的目的是评估术前 MAT 期间绝对手指压降（∂）与首次 HD 通路构建后的死亡率之间的可能关系。
2009 年 1 月至 2018 年 12 月在一个中心，在 CKD 患者接受通路手术前，使用数字容积描记法测量桡动脉和尺动脉受压后（mmHg）的收缩压。使用两个食指的最大∂进行分析。使用 ERA-EDTA 分类系统（代码 11、14-16、18、22-26、29）在接下来的 4 年内评估心血管和总死亡率。Cox 回归分析确定∂与死亡率之间的可能关联。
108 例患者的完整数据集可用（男性 71 例；年龄 70 岁±12 岁；平均随访（FU）1.6 年±0.1 年；FU 指数 99%±1%）。中位数∂为 31mmHg（范围 0-167mmHg）。患有心血管疾病（CV+）的患者表现出更高的∂值（CV+ 44±5mmHg 比 CV- 29±3mmHg，=0.012）。共有 26 例患者（24%）在 FU 期间死亡（CV+死亡，=16；62%）。∂每增加 10mmHg，总死亡率增加 10%，CV+死亡率增加 15%（总死亡率：HR 1.10[1.01-1.22]，=0.048；CV+死亡率：1.15[1.03-1.29]，=0.017）。校正年龄后，∂与 CV+死亡率仍相关（HR 1.13[1.00-1.26]，=0.043）。
术前 MAT 期间收缩压的大幅下降与初次 HD 通路手术后的死亡率相关。该潜在新风险参数的作用需要在更大的人群中得到证实。
