Wei Haining, Wang Xiaohe, Pang Hongquan, Fu Mingzhu, Li Rui, Hou Guocun
Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China.
Department of Nephrology, Suzhou Research Center of Medical School, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5073-5085. doi: 10.21037/qims-24-1815. Epub 2025 May 30.
Radio-cephalic arteriovenous fistula (RC-AVF) is regarded as favored choice for vascular access in patients undergoing hemodialysis. However, the mainstream surgical technique is associated with low primary patency rate. Recently, RC-AVF creation by modified no-touch technique (MNTT) is reported to increase primary patency and decrease juxta-anastomotic stenosis in initial small sample size and short-term follow-up study. This comparative study aims to investigate the hemodynamic discrepancies between RC-AVF created by MNTT and conventional technique (CT).
To further explore the differences between MNTT and CT, four-dimensional (4D) flow magnetic resonance imaging (MRI) was used to analyze the hemodynamic of RC-AVFs. Thirty patients who underwent 4D-flow MRI examination were included. Eighteen in the MNTT group and twelve in the CT group. Hemodynamic analysis was performed to measure blood flow velocity, vorticity, relative helicity, wall shear stress (WSS) and oscillatory shear index (OSI) in the artery and vein of RC-AVFs created by the two techniques.
The averaged velocity, vorticity and WSS was found higher in the MNTT group (velocity =0.771±0.029 m/s in artery, 0.955±0.055 m/s in vein; vorticity =529.115±50.006 1/s in artery, 709.895±43.180 1/s in vein; WSS =7.885±0.239 Pa in artery, 9.378±0.738 Pa in vein) than those in the CT group (velocity: 0.577±0.011 m/s in artery, 0.611±0.014 m/s in vein; vorticity =438.028±6.819 1/s in artery, 539.670±19.891 1/s in vein; WSS =5.611±0.213 Pa in artery, 5.314±0.279 Pa in vein) (P<0.001). The averaged relative helicity magnitude of artery in MNTT group was higher than that CT group (0.349±0.067 0.261±0.052, P<0.001).
Patients in the MNTT group had good prognosis related to the improved fistula hemodynamics.
桡动脉-头静脉动静脉内瘘（RC-AVF）被认为是接受血液透析患者血管通路的首选。然而，主流手术技术的一期通畅率较低。最近，在初始小样本量和短期随访研究中报道，采用改良非接触技术（MNTT）创建RC-AVF可提高一期通畅率并减少吻合口近端狭窄。本对比研究旨在探讨MNTT创建的RC-AVF与传统技术（CT）之间的血流动力学差异。
为进一步探究MNTT与CT之间的差异，采用四维（4D）血流磁共振成像（MRI）分析RC-AVF的血流动力学。纳入30例行4D血流MRI检查的患者。MNTT组18例，CT组12例。对两种技术创建的RC-AVF的动脉和静脉进行血流动力学分析，测量血流速度、涡度、相对螺旋度、壁面剪应力（WSS）和振荡剪切指数（OSI）。
发现MNTT组的平均速度、涡度和WSS高于CT组（动脉速度=0.771±0.029 m/s，静脉速度=0.955±0.055 m/s；动脉涡度=529.115±50.006 1/s，静脉涡度=709.895±43.180 1/s；动脉WSS =7.885±0.239 Pa，静脉WSS =9.378±0.738 Pa）（CT组动脉速度：0.577±0.011 m/s，静脉速度：0.611±0.014 m/s；动脉涡度=438.028±6.819 1/s，静脉涡度=539.670±19.891 1/s；动脉WSS =5.611±0.213 Pa，静脉WSS =5.314±0.279 Pa）（P<0.001）。MNTT组动脉的平均相对螺旋度幅值高于CT组（0.349±0.067对0.261±0.052，P<0.001）。
MNTT组患者因内瘘血流动力学改善而预后良好。
