背景：动静脉瘘和移植物是大多数血液透析患者的生命线，低接入流量通常需要与通畅相关的干预，如血管成形术或血栓切除术，以防止访问失败。我们检查了早期接入流量，初始瘘管/移植物插管后测量，预测1年内血管通路通畅相关干预。
方法：这是一项单中心回顾性队列研究。在172例接受瘘管/移植物手术的患者中，52（30.2%）记录了通过Transonic™超声稀释技术进行的访问流量测量，在初始插管后的平均48天内进行。需要与通畅相关的干预，被定义为正在经历一个图，血管成形术,血栓切除术,或者手术翻修,在1年内确定。生成受试者工作特征曲线（ROC），以评估首次和平均进入流速的诊断性能，以预测1年内与通畅相关的干预。
结果：52名研究对象中有28名（53.8%）在1年内需要通畅相关干预。他们的特征与不需要通畅相关干预的人没有显着差异。然而,与不需要通畅相关干预的患者相比，首次接入流速显着降低（898vs.1471mL/min；p=0.003），平均接入流量(841vs.1506mL/min；p<0.001）。ROC分析显示，首次接入流速和平均接入流速预测1年内需要通畅相关干预，ROC曲线下面积为0.743（95％置信区间[CI]0.608，0.877）和0.775（95％CI0.648，0.903），分别,表现出可接受的歧视。
结论：在接受血液透析的成年人中，早期通路流速测量可预测首次血管通路插管后1年内与通畅相关的介入治疗.需要进行其他研究以确认这些发现并确定最佳的通路流速截止值，以预测狭窄风险较高的血管通路。
BACKGROUND: Arteriovenous fistulas and grafts are lifelines for most hemodialysis patients, and a low access flow rate often requires patency-related intervention, such as angioplasty or thrombectomy, to prevent access failure. We examined whether early access flow rate, measured after initial fistula/graft cannulation, predicts vascular access patency-related intervention within 1 year.
METHODS: This was a single-center retrospective cohort
study. Among 172 patients undergoing surgical creation of a fistula/graft, 52 (30.2%) had documented access flow rates measurement by the Transonic™ ultrasound dilution technique, performed within an average of 48 days from initial access cannulation. The need for a patency-related intervention, defined as undergoing a
fistulogram, angioplasty, thrombectomy, or surgical revision, was ascertained within 1 year. A receiver-operating characteristic curve (ROC) was generated to evaluate the diagnostic performance of first and average access flow rates for predicting patency-related intervention within 1 year.
RESULTS: Twenty-eight (53.8%) of the 52
study subjects required a patency-related intervention within 1 year. Their characteristics were not significantly different from those who did not require patency-related interventions. However, first access flow rates were significantly lower in patients requiring patency-related intervention compared to those who did not (898 vs. 1471 mL/min; p = 0.003), as were average access flow rates (841 vs. 1506 mL/min; p < 0.001). The ROC analyses revealed that first access flow rates and average access flow rates predicted the need for patency-related intervention within 1 year, with an area under-the-ROC curve of 0.743 (95% confidence interval [CI] 0.608, 0.877) and 0.775 (95% CI 0.648, 0.903), respectively, demonstrating acceptable discrimination.
CONCLUSIONS: In adults undergoing hemodialysis, early access flow rate measurement can predict patency-related intervention within 1 year after initial vascular access cannulation. Additional studies are required to confirm these findings and identify optimal access flow rate cut-off values to predict vascular accesses at higher risk of stenosis.
