Abstract：
UNASSIGNED: Arteriovenous Fistula (AVF) surveillance is required to detect early dysfunction (thrombosis, stenosis) and its timely correction prolongs access-patency. Clinical examination (CE) and doppler have been used as screening/surveillance of AVF, for early detection of AVF dysfunction. Since there was inadequate evidence for KDOQI to make recommendations on AVF surveillance and on secondary failure rate. We compared CE, doppler and fistulogram as surveillance modalities in detecting a secondary failure in matured AVF.
UNASSIGNED: This prospective-observational, single-center study, was done between December 2019-April 2021. CKD stage 5 patients on dialysis/Not-on-dialysis with matured AVF were included at third month. CE, doppler (blood flow, vein diameter, depth), and fistulogram were done at third and sixth month. Secondary failure was assessed at sixth month classifying AVF to patent/functional and failed group. Diagnostic tests were performed by comparing three methods considering fistulogram as gold-standard. Residual urine output is also monitored to look for any contrast induced residual renal function loss.
UNASSIGNED: Of total 407 created AVF, 98 (24%) had primary failure. Twenty-five (6%) had surgical complications including unsuccessful AVF and aneurysm/rupture, 156 lost follow-up at third month, 104 consented patients were enrolled, 16 lost to follow-up subsequently, and 88 patients\' data were analyzed at the end. At the sixth month, 76(86.4%) had patent AVF, 8 (9.1%) had secondary failure (Thrombosis-4, Central Venous Stenosis-4), and 4 (4.1%) patients expired. Considering fistulogram as a diagnostic standard, CE showed 87.5% sensitivity, and 93.4% specificity (cohen\'s kappa value of 0.66). Doppler had sensitivity and specificity of 87% and 96% respectively (cohen\'s kappa value of 0.75), Combination of clinical examination with doppler showed sensitivity and specificity of 100% and 89% respectively.
UNASSIGNED: Although the secondary AVF failure rate is less than the primary, CE is an important and valuable tool in the diagnosis and surveillance of AVF in detecting its dysfunction. Moreover, CE with doppler can be used as a surveillance protocol that can detect early AVF dysfunction at par with Fistulogram.
UNASSIGNED: This prospective-observational, single-center study, was done between December 2019-April 2021. CKD stage 5 patients on dialysis/Not-on-dialysis with matured AVF were included at third month. CE, doppler (blood flow, vein diameter, depth), and fistulogram were done at third and sixth month. Secondary failure was assessed at sixth month classifying AVF to patent/functional and failed group. Diagnostic tests were performed by comparing three methods considering fistulogram as gold-standard. Residual urine output is also monitored to look for any contrast induced residual renal function loss.
UNASSIGNED: Of total 407 created AVF, 98 (24%) had primary failure. Twenty-five (6%) had surgical complications including unsuccessful AVF and aneurysm/rupture, 156 lost follow-up at third month, 104 consented patients were enrolled, 16 lost to follow-up subsequently, and 88 patients\' data were analyzed at the end. At the sixth month, 76(86.4%) had patent AVF, 8 (9.1%) had secondary failure (Thrombosis-4, Central Venous Stenosis-4), and 4 (4.1%) patients expired. Considering fistulogram as a diagnostic standard, CE showed 87.5% sensitivity, and 93.4% specificity (cohen\'s kappa value of 0.66). Doppler had sensitivity and specificity of 87% and 96% respectively (cohen\'s kappa value of 0.75), Combination of clinical examination with doppler showed sensitivity and specificity of 100% and 89% respectively.
UNASSIGNED: Although the secondary AVF failure rate is less than the primary, CE is an important and valuable tool in the diagnosis and surveillance of AVF in detecting its dysfunction. Moreover, CE with doppler can be used as a surveillance protocol that can detect early AVF dysfunction at par with Fistulogram.
摘要：
■需要进行动静脉瘘（AVF）监测以发现早期功能障碍（血栓形成，狭窄）及其及时矫正延长了通路通畅性。临床检查（CE）和多普勒已被用作AVF的筛查/监测，用于早期发现AVF功能障碍。由于KDOQI没有足够的证据就AVF监测和继发性失败率提出建议。我们比较了CE，多普勒和血管图作为检测成熟AVF继发故障的监测方式。
■这种前瞻性观察，单中心研究,是在2019年12月至2021年4月之间完成的。在第3个月纳入患有成熟AVF的透析/未透析的CKD5期患者。CE,多普勒（血流，静脉直径,深度),在第3个月和第6个月做了造象图。在第六个月评估继发性失败，将AVF分类为专利/功能和失败组。通过比较三种将纤维图作为金标准的方法进行诊断测试。还监测残余尿量以寻找任何造影剂诱导的残余肾功能损失。
■总共创建了407个AVF，98（24％）有主要失败。25例（6%）有手术并发症，包括不成功的AVF和动脉瘤/破裂，156个月失去随访，纳入104例同意的患者，随后失去了16名，和88例患者的数据在结束时进行了分析。在第六个月，76（86.4%）拥有专利AVF，8例（9.1％）继发衰竭（血栓形成-4，中心静脉狭窄-4），4例(4.1%)患者过期。考虑到纤维图作为诊断标准，CE显示87.5%的灵敏度，和93.4%的特异性（科恩的kappa值为0.66）。多普勒的敏感性和特异性分别为87％和96％（科恩κ值为0.75），临床检查与多普勒联合显示敏感性和特异性分别为100％和89％。
■尽管次级AVF故障率小于初级，CE是诊断和监测AVF检测其功能障碍的重要和有价值的工具。此外，CE与多普勒可以用作监测方案，可以与Fistulogram一样检测早期AVF功能障碍。
■这种前瞻性观察，单中心研究,是在2019年12月至2021年4月之间完成的。在第3个月纳入患有成熟AVF的透析/未透析的CKD5期患者。CE,多普勒（血流，静脉直径,深度),在第3个月和第6个月做了造象图。在第六个月评估继发性失败，将AVF分类为专利/功能和失败组。通过比较三种将纤维图作为金标准的方法进行诊断测试。还监测残余尿量以寻找任何造影剂诱导的残余肾功能损失。
■总共创建了407个AVF，98（24％）有主要失败。25例（6%）有手术并发症，包括不成功的AVF和动脉瘤/破裂，156个月失去随访，纳入104例同意的患者，随后失去了16名，和88例患者的数据在结束时进行了分析。在第六个月，76（86.4%）拥有专利AVF，8例（9.1％）继发衰竭（血栓形成-4，中心静脉狭窄-4），4例(4.1%)患者过期。考虑到纤维图作为诊断标准，CE显示87.5%的灵敏度，和93.4%的特异性（科恩的kappa值为0.66）。多普勒的敏感性和特异性分别为87％和96％（科恩κ值为0.75），临床检查与多普勒联合显示敏感性和特异性分别为100％和89％。
■尽管次级AVF故障率小于初级，CE是诊断和监测AVF检测其功能障碍的重要和有价值的工具。此外，CE与多普勒可以用作监测方案，可以与Fistulogram一样检测早期AVF功能障碍。
