Johnson C P, Zhu Y R, Matt C, Pelz C, Roza A M, Adams M B
Department of Transplant Surgery, Medical College of Wisconsin, Milwaukee, USA.
Surgery. 1998 Oct;124(4):729-37; discussion 737-8. doi: 10.1067/msy.1998.91364.
The purpose of this study was to correlate intraoperative blood flow measurements with outcome in vascular access surgery.
In 303 patients, 389 vascular access operations were performed. Intraoperative blood flow measurements were made immediately following construction of 227 autogenous and 162 prosthetic arteriovenous fistulas (AVFs) using a handheld flowprobe. Blood flow measurements were stratified by demographic variables such as age, race, sex, and presence of diabetes and were correlated with primary and secondary (assisted) patency. Statistical methods included life-table analysis and Cox proportional hazards model.
Blood flow increased progressively from distal to proximal access sites and was not significantly affected by age, race, sex, or presence of diabetes. Autogenous AVFs with flow rates at or below 320 mL/min and polytetrafluoroethylene (PTFE) grafts with flow rates at or below 400 mL/min had significantly worse primary and secondary patency rates compared to their higher flow counterparts at all sites. Using hazard analysis flow rate was the single most important determinant of primary and secondary patency. PTFE grafts with flow rates at or below 400 mL/min also required more interventions (1.58 per patient-year) and failed sooner (median time, 0.5 +/- 4.7 months) than grafts with flow rates above 400 mL/min (1.08 interventions per patient-year; P = .03; median time, 1.6 +/- 5.0 months; P = .003).
Intraoperative measurements of access blood flow provide objective, reliable data that correlate with outcome. Routine use of this technology might lead to more efficient management of patients undergoing hemodialysis access surgery.
本研究的目的是将血管通路手术中的术中血流测量结果与手术结局相关联。
对303例患者进行了389例血管通路手术。使用手持式血流探头，在构建227例自体动静脉内瘘（AVF）和162例人工血管动静脉内瘘后立即进行术中血流测量。血流测量结果按年龄、种族、性别和糖尿病等人口统计学变量进行分层，并与初次和二次（辅助）通畅率相关联。统计方法包括生存表分析和Cox比例风险模型。
血流从远端至近端通路部位逐渐增加，且不受年龄、种族、性别或糖尿病的显著影响。与所有部位血流较高的同类血管相比，血流速率等于或低于320 mL/min的自体AVF和血流速率等于或低于400 mL/min的聚四氟乙烯（PTFE）移植物的初次和二次通畅率明显更差。使用风险分析，血流速率是初次和二次通畅的唯一最重要决定因素。与血流速率高于400 mL/min的移植物相比（每位患者每年1.08次干预；P = 0.03；中位时间，1.6 +/- 5.0个月；P = 0.003），血流速率等于或低于400 mL/min的PTFE移植物还需要更多干预（每位患者每年1.58次），且失效更快（中位时间，0.5 +/- 4.7个月）。
术中测量通路血流可提供与结局相关的客观、可靠数据。常规使用该技术可能会使接受血液透析通路手术的患者得到更有效的管理。
