Pre-operative vessel mapping and early post-operative surveillance duplex scanning of arteriovenous fistulae.
Pre-operative vessel mapping and early post-operative surveillance duplex scanning of arteriovenous fistulae.
复制标题
术前血管测绘和术后早期动静脉瘘双重扫描监测。
DOI：
10.5301/jva.2009.1297
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
H. Lawson
中科院分区：
文献类型：
--
作者：
C. Ives;J. Akoh;J. George;E. Vaughan;H. Lawson
目的
为了增加使用自体动静脉内瘘（AVF）的透析患者比例，必须改进最合适手术的选择并结合抢先体验监测，以确定哪种通路可能成熟以及何时干预可能导致通路挽救。本研究旨在根据AVF成熟度的主要结局指标审核术前血管标测和术后入路监测。
方法
在2006年1月至2007年8月期间，对101例患者的113例AVF进行了研究。根据AVF结局分析术前血管标测、AVF类型、术后监测扫描数据。
结果
术前标测和术后扫描分别占86%和91%。术后扫描显示瘘管成熟与满意结局高度相关（p<0.001）。术后扫描的敏感性和特异性分别为100%和85%。有79例头臂瘘和34例放射头瘘，原发性失败率分别为23%和47%，总失败率为30%。9例瘘管接受了进一步干预（血管成形术或溶栓），5例（56%）被挽救。72例AVF成功成熟，一期累积通畅率为71%（72/102）。
结论
这项研究表明，术前血管标测提供了关于AVF选择的有用信息。在术后6-8周进行通路监测双功扫描是可行的，对瘘管的最终结局具有较高的敏感性和特异性。早期识别AVF的潜在问题意味着可以更早地计划进一步的干预或手术，这将对患者产生积极的影响。
PURPOSE
To increase the proportion of dialysis patients using native arteriovenous fistulae (AVF), improved selection of the most appropriate procedure must be coupled with early access surveillance to determine which access would likely mature and when intervention might lead to access salvage. This study was aimed at auditing pre-operative vessel mapping and post-operative access surveillance against the primary outcome measure of AVF maturation.
METHODS
Between January 2006 and August 2007, 113 AVF created in 101 patients were studied. Data on pre-operative vessel mapping, type of AVF, post-operative surveillance scans were analyzed against the outcome AVF.
RESULTS
Pre-operative mapping and post-operative scanning were carried out in 86% and 91%, respectively. A maturing fistula on post-operative scan highly correlated with a satisfactory outcome (p<0.001). The sensitivity and specificity of the post-operative scan were 100% and 85%, respectively. There were 79 brachiocephalic and 34 radiocephalic fistulae with a primary failure rate of 23% and 47%, respectively, giving an overall failure rate of 30%. Nine fistulae had further intervention (angioplasty or thrombolysis) and five (56%) were salvaged. Seventy-two AVF matured satisfactorily giving a primary cumulative patency of 71% (72/102).
CONCLUSION
This study shows that preoperative vessel mapping provides useful information regarding the choice of AVF. Access surveillance duplex scanning at 6-8 weeks post-operatively is viable and has a high sensitivity and specificity for final outcome of fistula. Identifying AVF with potential problems early means that further intervention or surgery can be planned earlier, which will have a positive impact on patients.