Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
J Vasc Access. 2022 Jul;23(4):508-514. doi: 10.1177/11297298211001158. Epub 2021 Mar 14.
About 18%-65% of Arterio-Venous fistula (AVF) made to facilitate haemodialysis in end stage renal disease patient fail to mature. This study was designed to evaluate the impact of clinical parameters and vascular haemodynamics on maturation of AVF on Indian patients.
This was a prospective observational study. Eligible patients' clinical profiles and vascular haemodynamics by Doppler ultrasonography were noted. All patients underwent radio-cephalic AVF on the non-dominant arm under local anaesthesia. Clinical definition was used to assess success rate of AVFs which is defined as successful six settings of satisfactory dialysis. Data were analysed using Stata/12.0 software. Independent -test, chi-square test, logistic regression analysis and multivariate analysis were used. The -value of <0.05 was considered significant.
A total of 205 patients were enrolled and analysed. Among clinical factors, age, sex, serum creatinine, hypertension had no significant association with failure (p = 0.5, 0.08, 0.76 and 0.74). Patient's BMI and presence of diabetes had significant impact on outcome ( < 0.001 and 0.02 respectively). Among vascular haemodynamics, radial vein diameter of >2.5 mm and radial artery flow rate >40 ml/min had no significant association with failure ( = 0.12 and 0.28). Diameter of radial artery (>2 mm) and intra-operatively immediate thrill were independent predictor of success (p = 0.002 and <0.001).
In the present study rate of fistula, maturation was 73.2% without any post-operative radiological intervention. Radial artery diameter >2 mm and presence of immediate thrill post-operatively were significantly associated with successful cannulation.
在接受终末期肾病血液透析治疗的患者中，大约有 18%-65%的动静脉瘘（AVF）未能成熟。本研究旨在评估临床参数和血管血液动力学对印度患者 AVF 成熟的影响。
这是一项前瞻性观察研究。记录合格患者的临床特征和多普勒超声检查的血管血液动力学。所有患者均在局部麻醉下于非优势臂行头静脉桡动脉内瘘。采用临床定义评估 AVF 的成功率，即成功完成 6 次满意透析的定义。数据使用 Stata/12.0 软件进行分析。采用独立样本 t 检验、卡方检验、逻辑回归分析和多变量分析。p 值<0.05 被认为具有统计学意义。
共纳入并分析了 205 例患者。在临床因素中，年龄、性别、血清肌酐、高血压与失败无显著相关性（p=0.5、0.08、0.76 和 0.74）。患者的 BMI 和糖尿病的存在对结果有显著影响（p<0.001 和 0.02）。在血管血液动力学方面，桡静脉直径>2.5mm 和桡动脉流量>40ml/min 与失败无显著相关性（p=0.12 和 0.28）。桡动脉直径（>2mm）和术中即刻震颤是成功的独立预测因素（p=0.002 和<0.001）。
在本研究中，瘘管形成率为 73.2%，无需任何术后影像学干预。桡动脉直径>2mm 和术后即刻震颤与成功穿刺显著相关。
