Yii Erwin, Lee Limi, Polkinghorne Kevan, Thwaites Stephen, Saunder Alan, Yii Ming Kon
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Vascular Surgery Unit at Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia.
Nephrology (Carlton). 2023 Mar;28(3):175-180. doi: 10.1111/nep.14142. Epub 2023 Jan 13.
Successful haemodialysis is dependent on optimal arteriovenous (AV) access flow. Although 600 ml/min is frequently quoted as the critical level for functional flow volume (Qa) according to the National Kidney Foundation guideline, this may not be applicable for the different configurations of AV fistulas (AVF) or AV grafts (AVG). This study evaluates ultrasound derived Qa measurement in the inflow brachial artery to autologous AVF in the forearm radiocephalic and arm brachiocephalic/basilic configurations in relation to significant flow related AV dysfunction.
Five hundred and eleven duplex ultrasound (DUS) scans were analysed in 193 patients. The end points were therapeutic intervention and/or thrombosis of AVF versus no complication within 3 months of the scan. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold Qa of the brachial artery supplying the AVF.
Of the 511 scans, 155 scans were assigned to the intervention group, that is, AVF requiring intervention or thrombosing within 3 months of the DUS. Using ROC curve analysis, the area under the curve (AUC) for all AVF is 0.90 (CI: 0.88-0.93) with an optimal threshold Qa of 686 ml/min. In forearm AVF, the threshold Qa is 589 ml/min while in arm AVF the threshold Qa is 877 ml/min. Forearm Qa is statistically different from arm Qa.
Forearm AVF Qa threshold at 589 ml/min is distinct from arm AVF Qa at 877 ml/min and these are predictive of the need for impending intervention or thrombosis due to flow-limiting stenosis.
成功的血液透析依赖于最佳的动静脉（AV）通路血流量。尽管根据美国国家肾脏基金会指南，600毫升/分钟常被引述为功能性血流量（Qa）的临界水平，但这可能不适用于不同构型的动静脉内瘘（AVF）或动静脉移植物（AVG）。本研究评估在前臂桡动脉-头静脉和上臂肱动脉-头静脉/贵要静脉构型的自体AVF中，通过超声测量流入肱动脉的Qa与显著的与血流相关的AV功能障碍之间的关系。
对193例患者的511次双功超声（DUS）扫描进行分析。终点为扫描后3个月内AVF的治疗干预和/或血栓形成与无并发症。采用受试者操作特征（ROC）曲线来确定供应AVF的肱动脉的最佳Qa阈值。
在511次扫描中，155次扫描被归入干预组，即DUS后3个月内需要干预或发生血栓形成的AVF。通过ROC曲线分析，所有AVF的曲线下面积（AUC）为0.90（CI：0.88 - 0.93），最佳Qa阈值为686毫升/分钟。在前臂AVF中，阈值Qa为589毫升/分钟，而在上臂AVF中，阈值Qa为877毫升/分钟。前臂Qa与上臂Qa在统计学上有差异。
前臂AVF的Qa阈值为589毫升/分钟，与上臂AVF的877毫升/分钟不同，这些阈值可预测因限流性狭窄而即将进行干预或发生血栓形成的必要性。
