Abstract：
BACKGROUND: Hemodialysis (HD) patients present an increased carotid intima-media thickness (CIMT) and calcified plaques, and studies have demonstrated that CIMT is predictor for cardiovascular death in this patient population; hence, the importance of identifying early non-invasive markers of atherosclerosis. We aim to propose a new three-perspective CIMT measuring method in HD population, and to further investigate the possible use and value of this method to predict outcomes.
METHODS: A cross-sectional study was conducted, the CIMT was measured with duplex ultrasound during the perioperative access planning. Software provided maximum CIMT in a 10 mm (mm) width of the common carotid artery. CIMT was measured in Right (R) and Left (L) carotid arteries, both in anterior (a), lateral (l), and posterior (p) view. The sum of these values (Ra+Rl+Rp+La+Ll+Lp) was completed and termed as Sixth Carotid Intimal (SCI) score. We stratified either in low (summation <4) or high (>=4) SCI score groups. Demographics, patency rates, complications, and mortality were collected; chi-square test was used for our analysis.
RESULTS: A total of 30 patients (mean age 49 years and 56% females) that underwent access creation in the upper arm from 2010 to 2016 were selected and studied. A low SCI score was found 19 patients and 11 had high SCI, no significant difference was observed in demographics, history cardiovascular disease, and clinical outcomes as early thrombosis, and primary, primary-assisted patency at 12 months. Interestingly, during the follow up period of 36 months a significant higher difference in late thrombosis rates occurred (63.6% vs 26.3%, p = .044) and a higher all-cause mortality (54.4% vs 15.7%, p = .025) in patients with SCI score group above 4.
CONCLUSIONS: The SCI score method, might offer a screening tool for traditional cardiovascular risk factors in HD patients. In this study, we demonstrate an increased rate in late thrombosis and mortality in those with high SCI. Further research is necessary to better define the role of CIMT in vascular surgical procedures.
METHODS: A cross-sectional study was conducted, the CIMT was measured with duplex ultrasound during the perioperative access planning. Software provided maximum CIMT in a 10 mm (mm) width of the common carotid artery. CIMT was measured in Right (R) and Left (L) carotid arteries, both in anterior (a), lateral (l), and posterior (p) view. The sum of these values (Ra+Rl+Rp+La+Ll+Lp) was completed and termed as Sixth Carotid Intimal (SCI) score. We stratified either in low (summation <4) or high (>=4) SCI score groups. Demographics, patency rates, complications, and mortality were collected; chi-square test was used for our analysis.
RESULTS: A total of 30 patients (mean age 49 years and 56% females) that underwent access creation in the upper arm from 2010 to 2016 were selected and studied. A low SCI score was found 19 patients and 11 had high SCI, no significant difference was observed in demographics, history cardiovascular disease, and clinical outcomes as early thrombosis, and primary, primary-assisted patency at 12 months. Interestingly, during the follow up period of 36 months a significant higher difference in late thrombosis rates occurred (63.6% vs 26.3%, p = .044) and a higher all-cause mortality (54.4% vs 15.7%, p = .025) in patients with SCI score group above 4.
CONCLUSIONS: The SCI score method, might offer a screening tool for traditional cardiovascular risk factors in HD patients. In this study, we demonstrate an increased rate in late thrombosis and mortality in those with high SCI. Further research is necessary to better define the role of CIMT in vascular surgical procedures.
摘要：
背景：血液透析（HD）患者的颈动脉内膜中层厚度（CIMT）和钙化斑块增加，研究表明，CIMT是该患者人群心血管死亡的预测因子；因此，识别动脉粥样硬化早期非侵入性标志物的重要性。我们的目标是提出一种新的HD人群三视角CIMT测量方法，并进一步研究该方法预测结果的可能用途和价值。
方法：进行了横断面研究，在围手术期入路计划期间,用双工超声测量了CIMT.软件在颈总动脉的10mm（mm）宽度中提供了最大CIMT。测量右（R）和左（L）颈动脉的CIMT，都在前(a)，横向(l)，和后视图（P）。完成这些值的总和(Ra+Rl+Rp+La+Ll+Lp),并称为第六颈动脉内膜(SCI)评分。我们在低（总和<4）或高（>=4）SCI评分组中进行了分层。人口统计,通畅率，并发症,和死亡率；我们的分析使用卡方检验。
结果：选择并研究了2010年至2016年在上臂进行通路创建的30例患者（平均年龄49岁，女性占56％）。SCI评分低19例，SCI高11例，人口统计学差异无统计学意义。心血管疾病病史，和早期血栓形成的临床结果，和主要的，12个月时的初级辅助通畅。有趣的是,在36个月的随访期间，晚期血栓形成发生率显着升高（63.6％vs26.3％，p=.044)和更高的全因死亡率(54.4%对15.7%，p=.025）在SCI评分高于4的患者组中。
结论：SCI评分方法，可能为HD患者的传统心血管危险因素提供筛查工具。在这项研究中,我们证实,SCI高患者的晚期血栓形成率和死亡率均增加.需要进一步的研究来更好地定义CIMT在血管外科手术中的作用。
方法：进行了横断面研究，在围手术期入路计划期间,用双工超声测量了CIMT.软件在颈总动脉的10mm（mm）宽度中提供了最大CIMT。测量右（R）和左（L）颈动脉的CIMT，都在前(a)，横向(l)，和后视图（P）。完成这些值的总和(Ra+Rl+Rp+La+Ll+Lp),并称为第六颈动脉内膜(SCI)评分。我们在低（总和<4）或高（>=4）SCI评分组中进行了分层。人口统计,通畅率，并发症,和死亡率；我们的分析使用卡方检验。
结果：选择并研究了2010年至2016年在上臂进行通路创建的30例患者（平均年龄49岁，女性占56％）。SCI评分低19例，SCI高11例，人口统计学差异无统计学意义。心血管疾病病史，和早期血栓形成的临床结果，和主要的，12个月时的初级辅助通畅。有趣的是,在36个月的随访期间，晚期血栓形成发生率显着升高（63.6％vs26.3％，p=.044)和更高的全因死亡率(54.4%对15.7%，p=.025）在SCI评分高于4的患者组中。
结论：SCI评分方法，可能为HD患者的传统心血管危险因素提供筛查工具。在这项研究中,我们证实,SCI高患者的晚期血栓形成率和死亡率均增加.需要进一步的研究来更好地定义CIMT在血管外科手术中的作用。
