Preoperative radial artery volume flow is predictive of arteriovenous fistula outcomes

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• 作者：Agnes Masengu ; MRCP^a ; ^b ; ^{amasengu@doctors.org.uk" class="auth_mail" title="E-mail the corresponding author} ; James McDaid ; PhD ; FRCS^a ; Alexander P. Maxwell ; MD ; PhD ; FRCP^a ; ^b ; Jennifer B. Hanko ; FRCP^a
• 刊名：Journal of Vascular Surgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：63
• 期：2
• 页码：429-435
• 全文大小：411 K

文摘

Guidelines recommend the creation of a wrist radiocephalic arteriovenous fistula (RAVF) as initial hemodialysis vascular access. This study explored the potential of preoperative ultrasound vessel measurements to predict AVF failure to mature (FTM) in a cohort of patients with end-stage renal disease in Northern Ireland.

Methods

A retrospective analysis was performed of all patients who had preoperative ultrasound mapping of upper limb blood vessels carried out from August 2011 to December 2014 and whose AVF reached a functional outcome by March 2015.

Results

There were 152 patients (97% white) who had ultrasound mapping and an AVF functional outcome recorded; 80 (54%) had an upper arm AVF created, and 69 (46%) had a RAVF formed. Logistic regression revealed that female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.12-5.55; P = .025), minimum venous diameter (OR, 0.6; 95% CI, 0.39-0.95; P = .029), and RAVF (OR, 0.4; 95% CI, 0.18-0.89; P = .026) were associated with FTM. On subgroup analysis of the RAVF group, RAVFs with an arterial volume flow <50 mL/min were seven times as likely to fail as RAVFs with higher volume flows (OR, 7.0; 95% CI, 2.35-20.87; P < .001).

Conclusions

In this cohort, a radial artery flow rate <50 mL/min was associated with a sevenfold increased risk of FTM in RAVF, which to our knowledge has not been previously reported in the literature. Preoperative ultrasound mapping adds objective assessment in the clinical prediction of AVF FTM.