Change in access blood flow over time predicts vascular access thrombosis
Change in access blood flow over time predicts vascular access thrombosis
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DOI：
10.1046/j.1523-1755.1998.00145.x
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发表时间：
1998-11-01
影响因子：
19.6
通讯作者：
Hakim, RM
中科院分区：
文献类型：
--
作者：
Neyra, NR;Ikizler, TA;Hakim, RM
血管通路血栓形成每年至少造成10亿美元的费用，占慢性血液透析患者住院治疗的25%。低血管通路血流量（低于800 ml/min）已被证明会适度增加随后三个月内血栓形成的相对风险。在本研究中，假设血管通路血流的时间依赖性减少可能更能预测随后的血栓形成，尤其是在血流超过800 ml/min的血管通路中，因为这将表明移植物中发生了严重的出口狭窄。对91例CHD患者的95次入路进行了18个月的前瞻性随访。每六个月通过超声稀释技术测量一次血管通路血流量。在三个研究期间记录血栓事件。在整个研究期间，共记录了95次访问中的34起血栓形成事件。血栓形成的通路在第一个观察期内血管通路血流量减少22%，在第二个观察期内进一步减少41%，而没有血栓形成的通路在第一个和第二个观察期内分别减少4%和增加15%。与血流无变化的通路相比，血管通路血流减少超过35%的通路的血栓形成相对风险估计增加13.6倍（95%，置信区间2.68至69.16）。在研究期间，所有患者的平均血管通路血流量无统计学差异。显示血管通路血流大幅（>15%）减少的通路与血栓形成的高风险相关。血管通路血流的连续测量可预测通路血栓形成。
Background Vascular access thrombosis accounts for at least $1 billion dollars in annual expenses and 25% of hospitalizations for chronic hemodialysis patients. Low vascular access blood flow (less than 800 ml/min) has been shown to modestly increase the relative risk for thrombosis in the subsequent three months. In this study, it is hypothesized that a time-dependent decrease in vascular access blood flow may be more predictive of subsequent thrombosis especially in vascular accesses with flows more than 800 ml/min, since it would indicate the development of a critical outlet stenosis in the graft.Methods. Ninety-five accesses in 91 CHD patients were prospectively followed over 18 months. Vascular access blood flow was measured every six months by the ultrasound dilution technique. Thrombotic events were recorded during the three study periods.Results. A total of 34 thrombotic events in 95 accesses were documented through the total study duration. Accesses that thrombosed had a 22% decrease in vascular access blood flow during the first observation period and a further 41% decrease during the second observation period as compared to 4% drop and 15% increase during the first and second observation periods, respectively, for accesses that did not thrombose. There was an estimated 13.6-fold (95%, confidence interval 2.68 to 69.16) increase in the relative risk of thrombosis for accesses with more than 35% decrease in vascular access blood flow compared to those accesses with no change in blood flow. There was no statistical difference in the average vascular access blood flow of all patients over the study period.Conclusions. Accesses that show a large (>15%) decrement in vascular access blood flow are associated with a high risk of thrombosis. Serial measurements of vascular access blood flow predict access thrombosis.