Minimal diameter of the fistula vein defines a significant stenosis in an autologous arteriovenous fistula / 中华肾脏病杂志

Objective To define a parameter of autologous arteriovenous fistula stenosis that limits the fistula function for hemodialysis in our country.Methods Retrospectively study the doppler ultrasound of patients who accepted the percutaneous transluminal angioplasty (PTA) therapy due to autogenous arteriovenous fistula dysfunction;identify the least diameter of the fistula vein and compare it with the corresponding data of well-functioned fistula.Determine which absolute diameter constitutes a hemodynamically significant stenosis in a radioeephalic autologous arteriovenous fistula by receiver operating characteristic curve (ROC curve).Result Forty-two patients were enrolled in the study.The average age of those patients was 54.63±2.44 years old.Twenty-one patients were female.Twenty-six fistula located on the left arm.The minimal diameter of the dysfunction fistula averaged 1.57±0.07 mm,while the average forearm fistula vein diameter was 4.04±0.23 mm,significantly smaller than those in the compare group-an average minimal fistula vein diameter of 3.34±0.11 mm and a forearm vein diameter of 5.36(4.52,6.45) mm (P ＜ 0.05).The control group contained sixty-eight patients.The average age of those patients was 52.56±2.00 years old.Thirty-one patients were female.Forty-nine fistula located on the left arm.It was quiet appropriate in using minimal diameter of the fistula vein to indicate the dysfunction istula with an under-curve area of 0.979,95％C1 0.959-0.998.The under-curve area would be at the largest level when meeting the cutoff point at 2.40mm,in which it could achieve the area of 0.853.Conclusions The minimal diameter of the dysfunction wrist autogenous arteriovenous fistula was much smaller than the functioned ones.Minimal diameter of the fistula vein may serve as an effective parameter in detecting dysfunction fistula.

Relation between autogenous arteriovenous fistula diameter and hemodynamic parameter / 中华肾脏病杂志

Objective To analyze the relationship between the least diameter of autogenous arteriovenous fistula and other parameters like flow rate and artery diameter. To identify an appropriate way in defining fistula stenosis. Methods Physical examination and Doppler ultrasound were used to examine the autogenous arteriovenous fistula of maintenance hemodialysis patients. Well?used wrist arteriovenous fistula was included. The least diameter of the fistula vein was found and marked by ultrasound, and the diameter and the distance between the point and the anastomotic stoma were measured. Diameters of different places along the cephalic vein of the fistula, including the forearm place, the place close to elbow and the upper arm place were measured by ultrasound. Meanwhile, diameter as well as flow velocity and flow rate of brachial artery, radial artery and ulnar artery were also measured. Result Sixty?eight patients were enrolled in the study. The average age of those patients was 52.56 ± 2.00 years old. Thirty?one patients were female. Forty?nine fistula were located on the left arm. The average diameter and flow rate of brachial artery were 5.72(5.34, 6.33) mm and 821.50 (540.50, 1075.00) ml/min, respectively. The average diameters of radial artery and ulnar artery were 3.95 ± 0.10mm and 3.17(2.73,3.75) mm, respectively. The least diameter of cephalic vein was 3.34 ± 0.11mm in average. The distance between the least place to the anastomotic stoma was 3.76±0.14cm in average. The diameter of forearm cephalic vein was averaged 5.36(4.52, 6.45) mm. Diameter of place close to elbow and the upper arm place in the cephalic vein were (5.57±0.12) mm and (5.80±0.14) mm, respectively. The least diameter of cephalic vein was positively and statistically associated with the diameter and flow rate of brachial artery as well as radial artery. The least diameter was also positively and statistically associated with the diameter of each place in the cephalic vein. Statistical inter?group difference was found when the division was based on the value of the least diameter. Conclusion sThe least diameter of the wrist autogenous arteriovenous fistula vein will indeed affect the whole diameter and flow rate of the fistula. The value of the least diameter is more closely associated with the fistula function rather than narrow rate.

Primary study in maturity status of native arteriovenous fistula on the wrist / 中华肾脏病杂志

Object To investigate the maturity status of the cephalic vein when the native arteriovenous fistula matures and set up indicators of a matured native arteriovenous fistula.Methods The diameter,flow rate and wall thickness of the cephalic vein were prospectively measured by Doppler ultrasound after the native fistula was created.Mature judgment was done by skilled nurses depending on their experience before the fistula was punctured.The ultrasound data was marked as proposed mature at the same time.After three times dialysis,if blood flow was fluent and complications such as prolonged bleeding time and hematoma were absent,fistula mature was confirmed.Results Thirty-one patients were admitted to the study,then fistula were matured.The average age of those patients was (52.93±3.21) years old.Thirteen patients were female.Twenty two fistula located on the left arm.Thirteen of the patients were diabetic nephropathy.The average diameter of cephalic vein was increased from (3.10±0.11) mm before surgery to (4.74±0.16) mm when the fistula was matured,though it was still smaller than 6 mm which K/DOQI guideline had recommended (P ＜ 0.05).The average mature period was (57.10±3.21) days.The matured fistula had an average high flow rate of (569.76±48.34) ml/min and wall thickness of (0.95±0.04) mm.The one-side 95％ credibility interval of the diameter,flow rate and wall thickness of cephalic vein was 4.44 mm,486.37 ml/min and 0.67 mm,respectively.Conclusions The diameter of cephalic vein in a matured native arteriovenous fistula in our study was significantly smaller than 6 mm which K/DOQI guideline had recommended.The indicators of native arteriovenous fistula mature in our country may different from abroad.

Characters and influential factors of vascular remolding after native arteriovenous fistula / 中华肾脏病杂志

Objective To finding out the characters of vascular remolding after the establishment of native arteriovenous fistula on the wrist,and exploring the influential factors.Methods Doppler ultrasound was used to monitor the diameter of cephalic vein,brachial artery,radial artery and ulnar artery at the time before the surgery and one day,one week,two weeks,four weeks and eight weeks after the surgery respectively.The tendency of the diameter change was analyzed.Results Twenty eight patients completed the whole monitor session,in which eleven were female.The average age of those patients was (53.68 ± 2.61) years old.Twelve of them were diabetic nephropathy.The diameters of all vessel were increased more rapidly at the first day than any other days after surgery(all P ＜ 0.01).The patients were divided into two groups depending on whether diabetic nephropathy.No significant difference was found between the two groups on the tendency of diameter change in cephalic vein and brachial artery (all P ＞ 0.05).However,the tendency of diameter change in radial artery and ulnar artery was statistically significant difference between the two groups (all P ＜ 0.05).Conclusions Cephalic vein,brachial artery,radial artery and ulnar artery are all apparently dilated on the first day after the surgery.The vascular dilation and diameter increasing become much slower after the period,the diameter tend to be stable.The primary diseases may affect the tendency of the diameter change in radial artery as well as ulnar artery.