背景:由于其耐用性和较低的并发症风险,成熟的动静脉瘘(AVF)是首选的血液透析通道。各种因素被认为是成熟的预测因子,包括静脉直径和接入类型。静脉扩张性,指的是静脉根据血流和压力的变化而扩张的能力,已经被提出作为成熟的潜在预测指标,但它的效用研究还很少。
方法:这是一项在区域麻醉下进行的AVF的单机构回顾性研究。静脉扩张性定义为使用止血带进行的术前超声静脉标测与在AVF创建前且没有止血带的区域阻滞后重复超声之间的目标静脉直径(TVD)的绝对和相对差异。
结果:46例患者首次接受了AVF手术,并在前瞻性维护的数据库中获得了扩张性。术前平均初始TVD为2.7mm,阻滞后为3.4mm。整个队列的无辅助成熟率为76%。在TVD绝对变化<0.5mm(Δ<0.5)的患者中,无辅助成熟率为63%(12/19),尽管95%的患者术前TVD>3mm。在Δ≥0.5mm的情况下,无辅助成熟率为85%(23/27,P=0.08),尽管术前静脉图TVD为2.3mm,75%的静脉图TVD<3mm.对于放射性AVF(n=26),Δ<0.5的无辅助成熟率为75%,Δ≥0.5的无辅助成熟率为94%(P=0.16),尽管术前静脉图TVD在92%和75%中>3mm,分别。Δ≥0.5mm的无辅助成熟曲线下ROC面积为0.68(P=0.26)。
结论:透析介入手术的质量需要优化非辅助成熟率。解释成熟动态过程的生理测量可能比单独的解剖测量更有意义。此处显示的结果表明,在标准静脉标测超声下,静脉扩张性可能比绝对静脉直径更好。
BACKGROUND: A mature arteriovenous fistula (AVF) is the preferred hemodialysis access due to its durability and lower risk of complications. Various factors have been implicated as predictors for maturation, including vein diameter and access type. Vein distensibility, which refers to the ability of the vein to dilate in response to changes in blood flow and pressure, has been proposed as a potential predictor for maturation, but its utility remains poorly studied.
METHODS: This is a single institution retrospective study of AVFs performed under regional anesthesia. Vein distensibility was defined as the absolute and relative difference in target vein diameter (TVD) between the preoperative ultrasound vein mapping performed with tourniquet and a repeat ultrasound after a regional block prior to the AVF creation and without a tourniquet.
RESULTS: 46 patients were underwent first time AVF surgery and had distensibility captured in a prospectively maintained database. The mean initial preoperative TVD was 2.7mm and after the block 3.4mm. The unassisted maturation rate for the entire cohort was 76%. In patients with an absolute change of TVD of <0.5mm (Δ<0.5), the unassisted maturation rate was 63% (12/19), even though 95% of the group had a preoperative TVD >3mm. In those with Δ≥0.5mm, the unassisted maturation rate was 85% (23/27, P = 0.08), even though the preoperative vein map TVD was 2.3 mm and 75% had a vein map TVD <3mm. For radiocephalic AVFs (n=26), the unassisted maturation rate was 75% for Δ<0.5 vs 94% for Δ≥0.5 (P=0.16), despite a preop vein map TVD >3mm in 92% vs 75%, respectively. The ROC area under the curve for unassisted maturation with Δ≥0.5 mm was 0.68 (P=0.26).
CONCLUSIONS: Quality in dialysis access surgery requires optimizing the unassisted maturation rate. A physiologic measure that accounts for the dynamic process of maturation may be more informative than anatomic measurements alone. The results shown here demonstrate that vein distensibility may be a better predictor than absolute vein diameter on standard vein mapping ultrasounds.