Cong Rui, Li Songxiu, Shi Shasha
Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, Liaoning Province, China.
Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, Liaoning Province, China.
Nefrologia (Engl Ed). 2025 Jan;45(1):77-86. doi: 10.1016/j.nefroe.2025.01.004.
As radiocephalic fistula is not necessarily appropriate for all patients with advanced kidney disease, our aim was to investigate the sensitive indicators that affect the functional primary patency of radiocephalic fistulas.
This prospective observational study included consecutive patients referred to the Second Hospital of Dalian Medical University for initial creation of radiocephalic fistula from July 2017 to December 2019. Preoperative ultrasound parameters, demographic characteristics, serum indicators and comorbidities were recorded. The functionality of radiocephalic fistulas would be assessed every 6 months until March 2023, following their unassisted maturation, unless AVF dysfunction, kidney transplantation, mortality or loss to follow-up occurred. Kaplan-Meier analysis was employed to illustrate differences in functional primary patency of radiocephalic fistulas, while log-rank tests were utilized to compare survival curves. Univariate and multivariable Cox proportional hazard models were performed, yielding hazard ratios and 95% confidence intervals. The significance level was set at 5% for a two-sided test.
The studies included a total of 182 patients who successfully underwent radiocephalic fistulas with primary unassisted maturation. The mean age of the study population was 58 years, with 66 percent being male. All AVFs were placed on the forearm, with 84% located on the left side. The primary patency rates of eleven parameters exhibited significant differences between groups stratified by cut-off values at different time points. Notably, the group with a peak systolic velocity of the radial artery near the elbow ≤59cm/s demonstrated a higher primary patency rate compared to the >59cm/s group at 2 years (78.4% vs 57.5%, P=0.026). In the univariate Cox proportional hazard models, the P values for gender, the diameter of radial artery near the elbow, the peak systolic velocity of radial artery near the elbow, the diameter of brachial artery near the elbow were less than 0.1. The multivariable Cox proportional hazard model revealed that only the peak systolic velocity of radial artery near the elbow exhibited a significant impact on the functional primary patency of radiocephalic fistula (HR=1.017, 95%CI 1.002-1.031, P=0.021).
The peak systolic velocity of the radial artery near the elbow is a significant risk factor for functional primary patency of radiocephalic fistula. Preoperative evaluation of the peak systolic velocity could allow to identify patients with a lower likelihood of long-term radiocephalic fistula patency, facilitating improved selection of candidates for radiocephalic fistula creation.
由于动静脉内瘘并非适用于所有晚期肾病患者，我们旨在研究影响头静脉桡动脉内瘘功能性一期通畅率的敏感指标。
这项前瞻性观察性研究纳入了2017年7月至2019年12月期间连续转诊至大连医科大学附属第二医院初次行头静脉桡动脉内瘘手术的患者。记录术前超声参数、人口统计学特征、血清指标和合并症。在头静脉桡动脉内瘘自然成熟后，每6个月评估一次其功能，直至2023年3月，除非发生动静脉内瘘功能障碍、肾移植、死亡或失访。采用Kaplan-Meier分析来说明头静脉桡动脉内瘘功能性一期通畅率的差异，同时使用对数秩检验比较生存曲线。进行单因素和多因素Cox比例风险模型分析，得出风险比和95%置信区间。双侧检验的显著性水平设定为5%。
该研究共纳入182例成功进行头静脉桡动脉内瘘且自然成熟的患者。研究人群的平均年龄为58岁，男性占66%。所有动静脉内瘘均位于前臂，84%位于左侧。在不同时间点按截断值分层的组间，11项参数的一期通畅率存在显著差异。值得注意的是，在2年时，肘前桡动脉收缩期峰值流速≤59cm/s组的一期通畅率高于>59cm/s组（78.4%对57.5%，P=0.026）。在单因素Cox比例风险模型中，性别、肘前桡动脉直径、肘前桡动脉收缩期峰值流速、肘前肱动脉直径的P值均小于0.1。多因素Cox比例风险模型显示，只有肘前桡动脉收缩期峰值流速对头静脉桡动脉内瘘的功能性一期通畅率有显著影响（HR=1.017，95%CI 1.002-1.031，P=0.021）。
肘前桡动脉收缩期峰值流速是头静脉桡动脉内瘘功能性一期通畅率的重要危险因素。术前评估收缩期峰值流速可识别出头静脉桡动脉内瘘长期通畅可能性较低的患者，有助于改进头静脉桡动脉内瘘造瘘候选者的选择。
