Preexisting intimal hyperplasia of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients
Preexisting intimal hyperplasia of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients
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DOI：
10.1053/ajkd.2003.50051
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发表时间：
2003-02-01
影响因子：
13.2
通讯作者：
Bang, BK
中科院分区：
文献类型：
--
作者：
Kim, YO;Song, HC;Bang, BK
背景：放射性头动静脉瘘（AVF）为血液透析提供了最佳的血管通路，但其早期衰竭的发生率仍然很高。桡动脉内膜增生（IH）常见于血液透析前尿毒症患者，但这种先前存在的内膜增生对放射性头源性avf早期衰竭的影响尚未见报道。因此，我们设计了这项研究：(1)调查IH的临床危险因素，(2)确定先前存在的桡动脉IH是否与放射性头部型AVF的早期衰竭有关。方法：桡动脉标本在放射性头侧AVF手术中采集。三色染色测定IH，术后随访AVF通畅12个月。结果：59例患者中，45例患者桡动脉有IH（76.2%）。IH患者（n = 45）比无IH患者年龄大（n = 14； 58 12比44±17；P = 0.003）。合并IH患者糖尿病发生率高于未合并IH患者（60.0% vs 28.6%, P = 0.004）。在这57例患者中，除了2例患者在研究结束前因avf未闭而死亡外，仅在IH患者中观察到瘘管衰竭（44例患者中有22例；50%对0%；P < 0.001）。avf失败组的内膜较avf正常组厚（93.1 +/- 37.5 μ m vs 45.6 +/- 17.4 μ m; P < 0.001）。结论：本研究提示血液透析患者放射性头部avf的早期衰竭与先前存在的桡动脉IH密切相关。
Background: The radiocephalic arteriovenous fistula (AVF), which provides the best vascular access for hemodialysis, continues to have a high incidence of early failure. Intimal hyperplasia (IH) of the radial artery is observed commonly in uremic patients before hemodialysis, but the impact of this preexisting IH on the early failure of radiocephalic AVFs has not been reported yet. Therefore, we designed this study to: (1) investigate clinical risk factors for IH, and (2) determine whether preexisting IH of the radial artery is associated with early failure of a radiocephalic AVF. Methods: Specimens from the radial artery were obtained during the radiocephalic AVF operation. IH was measured with trichrome staining, and AVF patency was prospectively followed up for 12 months after the operation. Results: Of the 59 patients, 45 patients had evidence of IH in their radial artery (76.2%). Patients with IH (n = 45) were older than those without IH (n = 14; 58 12 versus 44 +/- 17 years; P = 0.003). The incidence of diabetes mellitus in patients with IH was greater than that in patients without IH (60.0% versus 28.6%; P = 0.004). Of the 57 patients, except for 2 patients who died before the end point of the study with patent AVFs, fistula failure was observed only in patients with IH (22 of 44 patients; 50% versus 0%; P < 0.001). The intima was thicker in the failed-AVF group than the patent-AVF group (93.1 +/- 37.5 versus 45.6 +/- 17.4 mu m; P < 0.001). Conclusion: This study suggests that early failure of radiocephalic AVFs in hemodialysis patients is closely associated with preexisting IH of the radial artery.