Department of Surgery, Máxima Medical Center, Veldhoven.
Department of Surgery, Máxima Medical Center, Veldhoven.
J Vasc Surg. 2021 Jul;74(1):237-245. doi: 10.1016/j.jvs.2020.12.075. Epub 2021 Jan 5.
The aim of the present study was to assess whether a single measurement of the digital brachial index (DBI; systolic finger pressure/systemic pressure ratio), reflecting the arm's circulation, was associated with access patency in patients with severe chronic kidney disease scheduled for arteriovenous fistula (AVF) creation.
A bilateral DBI was obtained using digital plethysmography just before construction of the patient's first AVF from January 2009 to December 2017 at one center. A DBI of 80% to 99% was considered normal, and a DBI of <80% (low) or DBI of ≥100% (high) were considered abnormal. DBI values ipsilateral to the AVF were used for analysis. The primary and secondary access patency rates were calculated using reported standards and compared using standard statistical techniques.
Data sets of 163 patients were obtained (69 women; age, 71 ± 12 years). The median follow-up was 40 weeks (range, 0-104 weeks; follow-up index, 99% ± 1%). Patients with abnormal preoperative DBI values had lower 2-year primary patency rates (low DBI, 25% ± 11%; high DBI, 28% ± 6%; normal DBI, 49% ± 8%; P = .018). After correction for age, sex, hypertension, diabetes mellitus, cardiovascular disease, smoking status, and a history of ipsilateral central venous catheter use, an adjusted model demonstrated that abnormal DBI values conferred an increased risk of primary patency failure (low DBI [<80%]: hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.13-4.48; high DBI [≥100%]: HR, 1.74; 95% CI, 1.06-2.85; P < .030 for both). Patients with a low preoperative DBI had also had diminished secondary patency (HR, 2.86; 95% CI, 1.08-7.59; P = .035). In contrast, the diameters of the outflow veins did not determine access patency.
Patients with abnormal DBI values before AVF construction for hemodialysis had lower 2-year access patency rates compared with patients with a normal DBI. Plethysmographic finger measurements might have a role in the preoperative counseling of patients with severe chronic kidney disease requiring an AVF.
本研究旨在评估反映手臂循环的数字式肱动脉指数（DBI；指压收缩压/系统血压比）单次测量值是否与严重慢性肾脏病患者动静脉瘘（AVF）创建时的通路通畅性相关。
2009 年 1 月至 2017 年 12 月，在一个中心，使用数字容积描记法在患者首次 AVF 构建之前，对双侧 DBI 进行了测量。DBI 为 80%至 99%被认为正常，DBI <80%（低）或 DBI ≥100%（高）被认为异常。同侧 AVF 的 DBI 值用于分析。使用报告的标准计算主要和次要通路通畅率，并使用标准统计技术进行比较。
获得了 163 例患者的数据集（69 例女性；年龄，71 ± 12 岁）。中位随访时间为 40 周（范围，0-104 周；随访指数，99% ± 1%）。术前 DBI 值异常的患者，2 年主要通畅率较低（低 DBI，25% ± 11%；高 DBI，28% ± 6%；正常 DBI，49% ± 8%；P =.018）。校正年龄、性别、高血压、糖尿病、心血管疾病、吸烟状况以及同侧中心静脉导管使用史后，调整模型显示异常 DBI 值增加了主要通畅失败的风险（低 DBI [<80%]：风险比[HR]，2.25；95%置信区间[CI]，1.13-4.48；高 DBI [≥100%]：HR，1.74；95% CI，1.06-2.85；两者均 P<.030）。术前 DBI 较低的患者，次要通畅率也降低（HR，2.86；95% CI，1.08-7.59；P =.035）。相比之下，流出静脉的直径并不能决定通路通畅性。
与 DBI 正常的患者相比，AVF 构建前 DBI 值异常的患者 2 年通路通畅率较低。动静脉瘘术前，容积描记法手指测量可能在需要动静脉瘘的严重慢性肾脏病患者的术前咨询中发挥作用。
