Abstract：
OBJECTIVE: Functional and durable vascular access is needed for adequate hemodialysis. Arteriovenous fistula is preferred over prosthetic grafts or central venous catheters, but it is associated with high rates of primary failure and maturation failure. Preoperative mapping of arm vessels with color Doppler ultrasound (CDU) has been shown to be helpful in achieving better short and long-term outcomes. Unfortunately, is more time-consuming than a physical examination and requires an experienced examiner and special equipment; some authors defend that CDU should not be part of the routine preoperative assessment. We reported our experience in preoperative vessel mapping using color Doppler ultrasound to purpose a vascular access to the surgical team, surveillance of vascular access, and evaluation of main outcomes (primary failure, maturation failure, and patency).
METHODS: This is a single-center retrospective study that includes patients who attended a specific appointment for vascular access planning consultation between January 2019 and December 2021. A nephrologist performed the physical exam and vascular mapping and proposed to the vascular surgeon team a specific type and location of vascular access. Patients were followed until one month after the first hemodialysis through functioning vascular access.
RESULTS: In this study, 167 patients were evaluated (114 incident patients - chronic kidney disease stage 4 or 5 - and 53 prevalent patients - under hemodialysis through central venous catheter). The vascular accesses proposed by nephrologist were radial-cephalic arteriovenous fistula in 70 patients (41.9%), brachio-cephalic arteriovenous fistula in 50 patients (29.9%), brachio-basilic arteriovenous fistula in 34 patients (20.4%), arteriovenous graft in 8 patients (4.8%) and central venous catheter in 2 patients (1.2%). Vascular access was constructed in 141 patients: distal arteriovenous fistula in 57 patients (40.4%), brachio-cephalic arteriovenous fistula in 54 patients (38.3%), brachio-basilic AVF in 27 patients (19.1%), and arteriovenous graft in 3 patients (2.1%). The created access corresponds to the proposed access in 129 patients (91.5%). Twenty-two (15.6%) primary failures were registered. Distal arteriovenous fistulas and diabetes mellitus were associated with a higher risk of primary failure (OR=3.929 (1.485-10.392), p=0.004; OR=3.867 (1.235-12.113), p=0.014, respectively). The incidence of maturation failure at eight weeks was 4.8%. The primary patency at 6, 12 and 24 months was 76.3%, 70.4% and 49.2%. Primary assisted patency was 84.8% at 6 and 12 months and 81.3% at 24 months.
CONCLUSIONS: This study demonstrates that the study of the entire vascular territory performed with color Doppler ultrasound, within a multidisciplinary team of nephrologists and vascular surgeons, is associated with high rates of autologous access and very low rates of primary failure and maturation failure (almost unprecedented in the literature).
METHODS: This is a single-center retrospective study that includes patients who attended a specific appointment for vascular access planning consultation between January 2019 and December 2021. A nephrologist performed the physical exam and vascular mapping and proposed to the vascular surgeon team a specific type and location of vascular access. Patients were followed until one month after the first hemodialysis through functioning vascular access.
RESULTS: In this study, 167 patients were evaluated (114 incident patients - chronic kidney disease stage 4 or 5 - and 53 prevalent patients - under hemodialysis through central venous catheter). The vascular accesses proposed by nephrologist were radial-cephalic arteriovenous fistula in 70 patients (41.9%), brachio-cephalic arteriovenous fistula in 50 patients (29.9%), brachio-basilic arteriovenous fistula in 34 patients (20.4%), arteriovenous graft in 8 patients (4.8%) and central venous catheter in 2 patients (1.2%). Vascular access was constructed in 141 patients: distal arteriovenous fistula in 57 patients (40.4%), brachio-cephalic arteriovenous fistula in 54 patients (38.3%), brachio-basilic AVF in 27 patients (19.1%), and arteriovenous graft in 3 patients (2.1%). The created access corresponds to the proposed access in 129 patients (91.5%). Twenty-two (15.6%) primary failures were registered. Distal arteriovenous fistulas and diabetes mellitus were associated with a higher risk of primary failure (OR=3.929 (1.485-10.392), p=0.004; OR=3.867 (1.235-12.113), p=0.014, respectively). The incidence of maturation failure at eight weeks was 4.8%. The primary patency at 6, 12 and 24 months was 76.3%, 70.4% and 49.2%. Primary assisted patency was 84.8% at 6 and 12 months and 81.3% at 24 months.
CONCLUSIONS: This study demonstrates that the study of the entire vascular territory performed with color Doppler ultrasound, within a multidisciplinary team of nephrologists and vascular surgeons, is associated with high rates of autologous access and very low rates of primary failure and maturation failure (almost unprecedented in the literature).
摘要：
目的：充分的血液透析需要功能性和持久的血管通路。动静脉瘘优于人工移植物或中心静脉导管。但它与原发性失败和成熟失败的高比率有关。术前用彩色多普勒超声（CDU）绘制手臂血管有助于实现更好的短期和长期结果。不幸的是,比体格检查更耗时，并且需要经验丰富的检查者和特殊设备；一些作者认为CDU不应该成为常规术前评估的一部分。我们报告了我们使用彩色多普勒超声进行术前血管标测的经验，目的是为手术团队提供血管通路，血管通路的监测,和主要结果的评估(主要失败，成熟失败，和通畅性)。
方法：这是一项单中心回顾性研究，包括在2019年1月至2021年12月期间参加特定预约血管通路计划咨询的患者。肾脏科医生进行了体格检查和血管标测，并向血管外科医生团队提出了血管通路的特定类型和位置。通过功能性血管通路对患者进行随访，直到第一次血液透析后一个月。
结果：在这项研究中，评估了167例患者（114例事件患者-慢性肾脏病4或5期-和53例流行患者-通过中心静脉导管进行血液透析）。肾脏科医师建议的血管通路为70例（41.9％）的radial头动静脉瘘，50例患者（29.9%）的头臂动静脉瘘，34例（20.4%）患者的臂-贵重动静脉瘘，动静脉移植8例（4.8％），中心静脉导管2例（1.2％）。141例患者建立了血管通路：57例患者（40.4%）远端动静脉瘘，54例（38.3％）的肱-头动静脉瘘，27例患者（19.1%），动静脉移植3例(2.1%)。创建的访问对应于129名患者（91.5％）的建议访问。记录了22个（15.6％）主要故障。远端动静脉瘘和糖尿病与原发性衰竭的高风险相关（OR=3.929（1.485-10.392），p=0.004；OR=3.867（1.235-12.113），分别为p=0.014)。8周时成熟失败的发生率为4.8%。在6、12和24个月的主要通畅率为76.3％，70.4%和49.2%。初级辅助通畅率在6个月和12个月为84.8%，在24个月为81.3%。
结论：这项研究表明，用彩色多普勒超声对整个血管区域进行研究，在一个由肾病学家和血管外科医生组成的多学科团队中，与高的自体进入率和极低的原发性失败和成熟失败率相关（在文献中几乎是前所未有的）。
方法：这是一项单中心回顾性研究，包括在2019年1月至2021年12月期间参加特定预约血管通路计划咨询的患者。肾脏科医生进行了体格检查和血管标测，并向血管外科医生团队提出了血管通路的特定类型和位置。通过功能性血管通路对患者进行随访，直到第一次血液透析后一个月。
结果：在这项研究中，评估了167例患者（114例事件患者-慢性肾脏病4或5期-和53例流行患者-通过中心静脉导管进行血液透析）。肾脏科医师建议的血管通路为70例（41.9％）的radial头动静脉瘘，50例患者（29.9%）的头臂动静脉瘘，34例（20.4%）患者的臂-贵重动静脉瘘，动静脉移植8例（4.8％），中心静脉导管2例（1.2％）。141例患者建立了血管通路：57例患者（40.4%）远端动静脉瘘，54例（38.3％）的肱-头动静脉瘘，27例患者（19.1%），动静脉移植3例(2.1%)。创建的访问对应于129名患者（91.5％）的建议访问。记录了22个（15.6％）主要故障。远端动静脉瘘和糖尿病与原发性衰竭的高风险相关（OR=3.929（1.485-10.392），p=0.004；OR=3.867（1.235-12.113），分别为p=0.014)。8周时成熟失败的发生率为4.8%。在6、12和24个月的主要通畅率为76.3％，70.4%和49.2%。初级辅助通畅率在6个月和12个月为84.8%，在24个月为81.3%。
结论：这项研究表明，用彩色多普勒超声对整个血管区域进行研究，在一个由肾病学家和血管外科医生组成的多学科团队中，与高的自体进入率和极低的原发性失败和成熟失败率相关（在文献中几乎是前所未有的）。
