Is there a place for duplex screening of the brachial artery in the maturation of arteriovenous fistulas?
Is there a place for duplex screening of the brachial artery in the maturation of arteriovenous fistulas?
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DOI：
10.1111/j.1525-139x.2005.18320.x
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发表时间：
2005-05-01
影响因子：
1.6
通讯作者：
Basile, C
中科院分区：
文献类型：
--
作者：
Lomonte, C;Casucci, F;Basile, C
临床上存在一些明显成熟的自体动静脉内瘘。临床评价中的真实的问题是预测尚未明显成熟的AVF的最终结局。因此，有利的是制定客观的定量标准，在血管通路放置后早期应用，以评价AVF用于透析的适用性。本研究的目的是通过双功多普勒超声检查记录肱动脉桡头侧腕部AVF的构建和成熟产生的血流速度变化。在2003年的最后9个月，所有需要构建桡头动脉腕AVF的尿毒症患者均入选本研究：18例患者接受了此类手术。采用7.0 MHz成像/5.0 MHz多普勒探头对手肘上2 cm的肱动脉进行线性彩色多普勒超声扫描：在AVF构建前和AVF构建后1、7、28天和至少6个月测量动脉内径并计算其血流速度。基线时肱动脉内径和血流速度分别为4.3 +/- 0.7 mm和56.1 +/- 19.2 ml/min。1例患者术后第28天肱动脉血流速度为80.0ml/min，建立了新的动静脉瘘。当排除该AVF时，17个AVF的平均肱动脉血流速度在AVF构建后28天时为720.4 +/- 132.8 ml/min（中位数750 ml/min，范围480-890 ml/min），在AVF构建后258.0 +/- 63.0天时为997.6 +/- 259.7 ml/min。当分析17个AVF在不同时间点的肱动脉血流速度增加百分比时，与基线相比，最显著的增加发生在第1天（549.0%;第1天的平均血流速度，365.0 +/- 129.3 ml/min）。因此，第1天的血液流速代表第28天测量的血液流速的一半以上（50.7%）。然后增加不太陡峭，第7天和第1天之间增加了20.1%（第7天的平均血流速度为438.4 +/- 86.0 ml/min），第28天和第7天之间增加了64.3%，与第28天相比，第258.0 +/- 63.0天增加了38.5%。本研究能够通过肱动脉双功多普勒超声检查记录桡头侧腕部AVF成熟后肱动脉血流速度的变化。此措施可能有助于监测哪些AVF可能会失败。该筛查应结合临床评估，从而对AVF的成熟水平及其结局做出合理的判断。
Clinically there are some autogenous arteriovenous fistulas (AVFs) that are obviously mature. The real problem in clinical evaluation is in predicting the ultimate outcome of AVFs that are not clearly mature. Thus it would be advantageous to develop objective quantitative criteria to be applied early after vascular access placement in order to evaluate the suitability of AVFs for dialysis. The goal of this study was to document the blood flow rate modifications that the construction and maturation of a radiocephalic wrist AVF produce in the brachial artery by means of duplex Doppler ultrasonography. All incident uremic patients who needed the construction of a radiocephalic wrist AVF in the last 9 months of 2003 were enrolled in the study: 18 patients underwent such an operation. A linear color Doppler ultrasound scan was performed with a 7.0 MHz imaging/5.0 MHz Doppler probe by sampling the brachial artery 2 cm above the elbow: the internal diameter of the artery was measured and its blood flow rate calculated just before AVF construction and 1, 7, 28 days, and at least 6 months after AVF construction. The internal diameter and blood flow rate of the brachial artery were, respectively, 4.3 +/- 0.7 mm and 56.1 +/- 19.2 ml/min at baseline. A new AVF was constructed in one patient whose brachial artery blood flow rate was 80.0 ml/min at 28 days. When excluding this AVF, the mean brachial artery blood flow rate of the 17 AVFs was 720.4 +/- 132.8 ml/min (median 750 ml/min, range 480-890 ml/min) at 28 days and 997.6 +/- 259.7 ml/min 258.0 +/- 63.0 days after AVF construction. When analyzing the percent increase in brachial artery blood flow rate of the 17 AVFs at the different time points, the most dramatic one occurred at day 1 compared to the baseline (549.0%; mean blood flow rate at day 1, 365.0 +/- 129.3 ml/min). Thus the blood flow rate at day 1 represents more than half (50.7%) of the blood flow rate that will be measured at day 28. Then the increase was less steep, with a 20.1% increase between day 7 and day 1 (mean blood flow rate at day 7, 438.4 +/- 86.0 ml/min), a 64.3% increase between day 28 and day 7, and a 38.5% increase at 258.0 +/- 63.0 days compared to 28 days. The present study was able to document the changes in brachial blood flow rate consequent to a radiocephalic wrist AVF maturation by means of duplex Doppler ultrasonography of the brachial artery. This measure may be helpful in monitoring which AVFs will probably fail. This screening should integrate clinical assessment, thus allowing sound judgment of the level of maturation of an AVF and of its outcome.