■为了评估使用超声对血液透析血管通路(VA)结果的常规监测的实施情况,并确定纠正的次数和频率,执行监督指导程序。
■多中心,prospective,观察性研究,包括连续接受自体动静脉瘘(AVF)或移植物(AVG)治疗的血液透析患者。从2019年1月至2021年12月,参与者被分配到常规的VA彩色多普勒超声监测(DUS)方案。根据临床或DUS发现(先发制人程序;PEP),将患者转诊为矫正程序(血管内或手术)。主要终点是估计原发性无辅助(PUP)和继发性通畅(SP)率。次要终点是确定PEP和VA生存率的数量和频率。
■总共,包括223例243VA患者(192AVF和51AVG)。12个月时,访问PUP和SP率分别为83%和93%,24个月时的75%和88%,在36个月的随访中,分别为72%和83%。12个月时自体瘘PUP和SP分别为89%和96%,81%和93%在24个月,在36个月时分别为80%和89%,分别。移植物PUP和SP在12个月时分别为56%和80%,44%和65%在24个月,在36个月时分别为39%和54%,分别。总的来说,执行了56个纠正程序(38/56PEP;65.5%)(0.13个程序/年),其中34例发生在AVF患者中(0.09次手术/年),22例发生在AVG患者中(0.40次手术/年)。总的来说,发生33VA损失(0.06故障/年),17在AVF(0.04故障/年),AVG患者16例(0.20例失败/年)。
■使用DUS可以及时诊断功能障碍,令人满意的VA总生存率,和通畅率,PEP频率低。需要随机对照试验来确定DUS监测对通畅性的价值以及DUS指导的干预措施是否可以改善VA结局。
UNASSIGNED: To evaluate the implementation of routine surveillance using ultrasound on hemodialysis vascular access (VA) outcomes and determine the number and frequency of corrective, surveillance-guided procedures performed.
UNASSIGNED: Multicenter, prospective, observational study that includes consecutive hemodialysis patients receiving therapy from native arteriovenous fistulae (AVF) or grafts (AVG). Participants were assigned to a routine VA Color Doppler ultrasound surveillance (DUS) protocol from January 2019 to December 2021. Patients were referred for corrective procedures (endovascular or surgical) based on clinical or DUS findings (pre-emptive procedures; PEP). Primary endpoint was the estimation of primary unassisted (PUP) and secondary patency (SP) rates. Secondary endpoints were the determination of the number and frequency of PEP and VA survival rates.
UNASSIGNED: In total, 223 patients with 243 VA (192 AVF and 51 AVG) were included. Access PUP and SP rates were 83% and 93% at 12 months, 75% and 88% at 24 months, and 72% and 83% at 36 months follow-up. Autologous fistulae PUP and SP were 89% and 96% at 12 months, 81% and 93% at 24 months, and 80% and 89% at 36 months, respectively. Graft PUP and SP were 56% and 80% at 12 months, 44% and 65% at 24 months, and 39% and 54% at 36 months, respectively. In total, 56 corrective procedures (38/56 PEP; 65.5%) were performed (0.13 procedures/year), of which 34 were in AVF patients (0.09 procedures/year) and 22 in AVG patients (0.40 procedures/year). Overall, 33 VA losses occurred (0.06 failures/year), 17 in AVF (0.04 failures/year), and 16 in AVG patients (0.20 failures/year).
UNASSIGNED: The use of DUS resulted in the timely diagnosis of dysfunction, satisfactory overall VA survival, and patency rates, with a low PEP frequency. Randomized controlled trials are required to establish the value of DUS surveillance on access patency and whether DUS-guided interventions could improve VA outcomes.