Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use
Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use
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DOI：
10.5301/jva.5000210
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发表时间：
2014-07-01
影响因子：
1.9
通讯作者：
Wilmink, Teun
中科院分区：
文献类型：
--
作者：
Ferring, Martin;Henderson, John;Wilmink, Teun
目的：评价早期临床和超声(US)检查对预测动静脉瘘(AVF)透析使用的准确性。方法：对未闭的AVF在造瘘4周后进行体检和超声检查。AVF的透析使用定义为连续使用AVF至少6次，使用两个针头，血流量超过200毫升/分钟。结果：119例AVF在4周内获得成功，26例(22%)失败。临床检查对预测透析成功的敏感性为96%，但对失败的特异性仅为21%。静脉内径>5 mm和动脉舒张期末期血流速度>110 cm/S是预测透析使用的最佳超声指标。在预测成熟度方面，静脉内径略好于动脉血流(敏感性：83%对67%，特异性：68%对65%)。所有评估对AVF成熟度的预测(阳性预测值：临床=81%，超声直径=90%，超声速度=87%)均明显好于AVF失败(阴性预测值：临床=63%，US直径=53%，US速度=37%)。结论：术后1个月，新的动静脉动静脉直径<5 mm的动静脉动静脉可能用于透析。不符合这些标准的AVF故障风险增加，可能需要进一步调查。
Aim: The aim of this article is to assess the accuracy of early clinical and ultrasound (US) examination in terms of predicting arteriovenous fistula (AVF) dialysis use.Methods: Physical and US examination of patent AVF was performed 4 weeks after fistula creation. AVF dialysis use was defined as subsequent use of an AVF for at least six consecutive dialysis sessions with two needles and a blood flow of more than 200 mL/min.Results: Of 119 AVF patent at 4 weeks, 26 (22%) failed. Clinical examination was 96% sensitive for predicting successful dialysis, but only 21% specific for failure. Vein diameter above 5 mm and an arterial end-diastolic velocity above 110 cm/s were the best US predictors for dialysis use. Vein diameter was slightly better than arterial velocity in terms of predicting maturity (sensitivity: 83% vs 67%, specificity: 68% vs 65%). All assessments predicted AVF maturity (positive predictive value: clinical = 81%, US diameter = 90%, US velocity = 87%) much better than AVF failure (negative predictive value: clinical = 63%, US diameter = 53%, US velocity = 37%).Conclusion: One month after surgery, a new AVF with a thrill or a vein diameter >5 mm is likely to be used for dialysis. An AVF not meeting these criteria has an increased risk of failure and further investigations may be required.