Chai Siew Cheng, Sanip Zulkefli, Ghulam Rasool Aida Hanum, Shokri Amran Ahmed, Halim Ahmad Sukari, Mat Saad Arman Zaharil, Wan Sulaiman Wan Azman
Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia.
J Res Med Sci. 2022 Jun 30;27:46. doi: 10.4103/jrms.JRMS_908_19. eCollection 2022.
This study aimed to determine changes in microvascular endothelial function with upper arm arteriovenous fistula (AVF) creation and maturation in patients with chronic kidney disease (CKD).
This prospective cross-sectional study was performed at Hospital Universiti Sains Malaysia, a tertiary hospital in Malaysia. Forty CKD patients (stage 4-5) who were scheduled for elective AVF creation over the upper extremity for maintenance hemodialysis were recruited using convenience sampling method. Microvascular endothelial-dependent vasodilation was measured using laser Doppler flowmetry and the process of iontophoresis preoperatively and postoperatively at weeks 2 and 6. Fistula maturation was assessed at week 6.
Thirty-two patients had successful AVF maturation. Endothelial-dependent vasodilation (acetylcholine (Ach)% was higher (246.48 [standard deviation (SD) 209.38] vs. 104.95 [SD 43.29], = 0.001) while systolic blood pressure was lower (142.25 [SD 21.50] vs. 162.25 [SD 13.26], = 0.017) in this group as compared to unsuccessful AVF group. No significant changes were seen in overall microvascular endothelial-dependent vasodilation during the 6-week study period (day 0, 246.48 [SD 209.38]; week 2, 201.14 [SD 198.19]; and week 6, 203.53 [SD 145.89]).
Upper arm AVF creation does not affect microvascular endothelial function up to 6 weeks post operation and may not contribute to the success of AVF maturation. However, the lower microvascular endothelial-dependent vasodilation and higher systolic blood pressure in unsuccessful AVF subjects need to be further studied.
本研究旨在确定慢性肾脏病（CKD）患者创建上臂动静脉内瘘（AVF）及其成熟过程中微血管内皮功能的变化。
本前瞻性横断面研究在马来西亚一家三级医院——马来西亚理科大学医院进行。采用便利抽样法招募了40例计划在上肢进行择期AVF创建以维持血液透析的CKD患者（4-5期）。术前以及术后第2周和第6周使用激光多普勒血流仪和离子导入法测量微血管内皮依赖性血管舒张。在第6周评估内瘘成熟情况。
32例患者的AVF成功成熟。与AVF未成功组相比，该组内皮依赖性血管舒张（乙酰胆碱（Ach）%）更高（246.48[标准差（SD）209.38]对104.95[SD 43.29]，P = 0.001），而收缩压更低（142.25[SD 21.50]对162.25[SD 13.26]，P = 0.017）。在为期6周的研究期间，总体微血管内皮依赖性血管舒张未见显著变化（第0天，246.48[SD 209.38]；第2周，201.14[SD 198.19]；第6周，203.53[SD 145.89]）。
上臂AVF创建术后6周内不影响微血管内皮功能，可能与AVF成熟成功无关。然而，AVF未成功患者较低的微血管内皮依赖性血管舒张和较高的收缩压需要进一步研究。
