Guo Xuemei, Liu Jiali, Xiao Ningting, Zhang Hongbo, Wang Jingzhu, Duan Zhiqiang, Zhang Heping, Jing Xueming
Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China.
Ann Vasc Surg. 2025 Jan;110(Pt A):189-196. doi: 10.1016/j.avsg.2024.07.120. Epub 2024 Sep 27.
To explore the trends of venous diameter and brachial artery volume flow (VF) in 12 weeks after arteriovenous fistula (AVF) and the influence of preoperative arterial diameter on this trend. Our goal was to clarify the maturation process within 12 weeks after AVF surgery.
Clinical data of 257 patients with end-stage renal disease who had their first radial-cephalic AVF established at our institution from February 1, 2023, to February 1, 2024, were included. The patients were divided into group A (radial artery diameter <1.5 mm), group B (radial artery diameter 1.5-2.0 mm), and group C (radial artery diameter >2.0 mm) according to the preoperative radial artery diameter. After AVF surgery, the artery and vein diameter and brachial artery VF were recorded at 1 day, 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, and 12 weeks.
The venous diameter and brachial artery VF of AVF showed an upward trend and increased significantly in 1 day-6 weeks postoperatively (P < 0.05), especially between 1 day and 2 weeks, while no significant difference in the increases at 6-12 weeks. Groups B and C were in line with the above trend, whereas the patients in group A showed best growth in 2-4 weeks postoperatively. The natural maturation rates of AVF in groups B and C were significantly better than that of group A at all postoperative time (P＜0.05).
The AVF was in a developmentally dominant stage at 6 weeks postoperatively, with 1 day-2 weeks being particularly prominent. The postoperative natural maturation rate of AVF with arteries diameter of <1.5 mm was low; the direct use of such arteries to establish AVF needs careful consideration.
探讨动静脉内瘘（AVF）术后12周内静脉直径和肱动脉血流量（VF）的变化趋势以及术前动脉直径对该趋势的影响。我们的目标是阐明AVF手术后12周内的成熟过程。
纳入2023年2月1日至2024年2月1日在我院首次行桡动脉-头静脉AVF的257例终末期肾病患者的临床资料。根据术前桡动脉直径将患者分为A组（桡动脉直径<1.5mm）、B组（桡动脉直径1.5 - 2.0mm）和C组（桡动脉直径>2.0mm）。AVF术后，在术后1天、2周、4周、6周、8周、10周和12周记录动静脉直径和肱动脉VF。
AVF的静脉直径和肱动脉VF呈上升趋势，术后1天至6周显著增加（P<0.05），尤其是在1天至2周之间，而在6至12周增加无显著差异。B组和C组符合上述趋势，而A组患者在术后2至4周生长最佳。B组和C组AVF的自然成熟率在所有术后时间均显著优于A组（P＜0.05）。
AVF在术后6周处于发育优势阶段，1天至2周尤为突出。动脉直径<1.5mm的AVF术后自然成熟率低；直接使用此类动脉建立AVF需谨慎考虑。
