Regular ultrasonographic screening significantly prolongs patency of PTFE grafts
Regular ultrasonographic screening significantly prolongs patency of PTFE grafts
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DOI：
10.1111/j.1523-1755.2005.00236.x
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发表时间：
2005-04-01
影响因子：
19.6
通讯作者：
Tuka, V
中科院分区：
文献类型：
--
作者：
Malik, J;Slavikova, M;Tuka, V
背景资料。尽管使用了复杂的筛查监测方法(静脉压力、通道流量)，聚四氟乙烯(PTFE)透析移植物的通畅率比自然动静脉瘘要短得多。PTFE移植物经常用于皮下静脉衰竭的受试者，因此保留通路专利是至关重要的。我们推测，定期双功多普勒超声筛查通路狭窄，加上及早治疗，将延长PTFE移植物的通畅率。我们对192名受试者进行了一项关于聚四氟乙烯移植物累积通畅率的随机前瞻性研究。第1组在传统筛查的基础上，每隔3个月定期进行一次超声检查(即定期在血液透析室进行通路检查，监测静脉压力和通路流量)。第2组只进行常规筛查(不使用超声)。肾内科医生、血管外科医生对可疑狭窄进行了干预，在第1组中，超声检查也提示了介入治疗。使用经典的超声诊断显著狭窄的标准，即使入口流量没有减少。平均随访392+/-430天。两组在年龄、性别、糖尿病状况和既往放弃就诊次数方面相似。第1组通畅时间明显延长(P<；0.001)。介入次数分别为2.1+/-1.8次和1.3+/-1.0次。定期筛查双功多普勒超声可显著延长PTFE移植物的通畅期，这是因为及早发现了狭窄，因此更频繁地对狭窄进行选择性干预。
Background. Polytetrafluoroethylene (PTFE) dialysis grafts have considerably shorter patency than native arteriovenous fistulas, despite the use of a complex of screening monitoring methods (venous pressure, access flow). PTFE grafts are used often in subjects with depleted subcutaneous veins after previous abandoned accesses, so keeping the access patent is crucial. We hypothesized that regular duplex Doppler ultrasound screening for access stenoses, together with their sooner treatment, would prolong PTFE graft patency.Methods. We performed a randomized, prospective study of PTFE grafts' cumulative patency in 192 subjects. In group 1, regular ultrasound examinations performed every 3 months was added to traditional screening (i.e., regular access examination at hemodialysis unit, monitoring of venous pressure and access flow). Group 2 was screened only traditionally (without ultrasound). Interventions of suspected stenoses were indicated by nephrologists, vascular surgeon, and, in group 1, also by ultrasonography. Classic ultrasound criteria for significant stenosis were used, even if the access flow had not been decreased. The mean follow-up lasted 392 +/- 430 days.Results. Groups were similar with respect to age, gender, diabetes status, and number of previous abandoned accesses. Group 1 had significantly longer access patency (P < 0.001). Number of interventions per graft was 2.1 +/- 1.8 and 1.3 +/- 1.0 in group 1 and group 2.Conclusions. Regular screening duplex Doppler ultrasonography results in significantly longer PTFE graft patency due to early detection of access stenosis and, thus, more frequent elective interventions of access stenoses.