Mount Sinai Hospital, New York, NY.
Massachusetts General Hospital, Boston, MA.
Ann Vasc Surg. 2023 Oct;96:316-321. doi: 10.1016/j.avsg.2023.03.027. Epub 2023 Apr 5.
Successful arteriovenous fistula (AVF) maturation and use for dialysis is highly dependent on preoperative diameter. Small veins (<2 mm) exhibit high failure rates and are typically avoided. This study investigates the effects of anesthesia on the distal cephalic vein diameter as compared to preoperative outpatient vein mapping for the purpose of hemodialysis access creation.
One hundred eight consecutive procedures for dialysis access placement met inclusion criteria and were reviewed. All patients received preoperative venous mapping and postanesthesia ultrasound mapping (PAUS). All patients received either regional and/or general anesthesia. A multiple regression was conducted to determine predictors of venous dilatation. The independent variables included both demographical and operative-specific variables such as the type of anesthesia. Outcomes of fistula maturation (successful cannulation and dialysis) were analyzed.
In this cohort, the mean preoperative vein diameter was 1.85 mm and the mean PAUS diameter was 3.45 mm, a 2.21× increase, with only 2 patient veins failing to increase in diameter. Smaller veins (<2 mm) exhibited significantly more dilation than larger veins after anesthesia (2.73 vs. 1.47×, P < 0.001). In the multiple regression analysis, smaller vein diameter was correlated with a significantly greater degree of dilation (P < 0.001). The degree of venous dilation was not affected by patient demographic-specific factors or by the type of anesthesia (regional block versus general) in the multiple regression analysis. 6 month follow-up data for fistula maturation was available for 75 of 108 patients. Small veins (<2 mm) on preoperative ultrasound matured at a similar rate as larger veins (90% vs. 91.4%, P = 0.833).
Small caliber distal cephalic veins experience a significant degree of dilation under regional and general anesthesia and can successfully be used for AVF creation. Consideration should be made to perform a postanesthesia vein mapping for all patients undergoing access placement despite preoperative venous mapping results.
动静脉瘘（AVF）的成熟和用于透析的成功高度依赖于术前直径。小静脉（<2mm）的失败率很高，通常会被避免。本研究旨在探讨与术前门诊静脉图相比，麻醉对远端头静脉直径的影响，以便为血液透析通路的建立创造条件。
连续 108 例透析通路放置手术符合纳入标准并进行了回顾性研究。所有患者均接受术前静脉图和麻醉后超声图（PAUS）检查。所有患者均接受区域和/或全身麻醉。进行多元回归分析以确定静脉扩张的预测因素。自变量包括人口统计学和手术特异性变量，如麻醉类型。分析瘘成熟（成功穿刺和透析）的结果。
在本队列中，术前静脉直径平均为 1.85mm，PAUS 直径平均为 3.45mm，增加了 2.21 倍，只有 2 根静脉的直径没有增加。较小的静脉（<2mm）在麻醉后明显比大静脉扩张更多（2.73 倍与 1.47 倍，P<0.001）。多元回归分析显示，较小的静脉直径与更大的扩张程度呈显著相关（P<0.001）。在多元回归分析中，静脉扩张程度不受患者人口统计学因素或麻醉类型（区域阻滞与全身麻醉）的影响。108 例患者中有 75 例获得了 6 个月瘘成熟的随访数据。术前超声显示小静脉(<2mm)的成熟率与大静脉相似（90%与 91.4%，P=0.833）。
小口径远端头静脉在区域和全身麻醉下经历了显著的扩张程度，可以成功用于 AVF 建立。尽管术前静脉图结果良好，仍应考虑对所有接受通路放置的患者进行麻醉后静脉图检查。
