The feasibility study of ultrasound evaluation for brachial artery elasticity in patients with chronic renal failure / 中国医师进修杂志

ABSTRACT

Objective To investigate the application of high-frequency ultrasound in pre-operative evaluation of brachial artery elasticity in chronic renal failure patients planning arteriovenous fistula formation.Methods A total of 65 patients with chronic renal failure undergoing radial artery-cephalic vein fistula (chronic renal failure group) and 40 healthy adults (control group) were selected.The elastic modulus (EM) of brachial artery was calculated by ultrasound.All subjects were divided into 5 subgroups according to age (≥50 years),hypertension,diabetes and chronic glomerulonephritis.Patients in subgroup 0 (28 cases),subgroup 1 (22 cases),subgroup 2 (24 cases),subgroup 3 (20 cases),subgroup 4 (11 cases) had 0,1,2,3 and 4 risk factors respectively.Results The levels of systolic blood pressure,pulse pressure,serum creatinine,and the EM of brachial artery in chronic renal failure group were higher than those in control group(20.65 ± 1.32) kPa vs.(16.38 ± 1.08) kPa,(8.64 ±0.51) kPa vs.(7.12 ±0.35) kPa,(637.3 ± 116.5) μ mol/L vs.(84.7 ±31.1) μmol/L,(132.96 ± 11.78) kPa vs.(102.16 ± 10.10) kPa,and there were significant differences (P ＜ 0.01 or ＜ 0.05).The single factor correlation analysis showed that age in control group,serum creatinine in chronic renal failure group and systolic blood pressure in two groups were significantly positively correlated with the EM of brachial artery(r =0.636,0.548,0.703; P ＜ 0.01).With the increase of risk factors,the EM of brachial artery increased gradually(96.21 ±9.82),(104.45 ± 10.55),(114.87 ± 11.15),(127.26 ± 12.43),(143.54 ± 12.81) kPa in subgroup 0,subgroup 1,subgroup 2,subgroup 3,subgroup 4,and there were significant differences (F=17.43,P＜ 0.05).The EM of brachial artery increased significantly in subgroup 3 and 4 with multiple risk factors.Conclusions Brachial artery elasticity measured by high-frequency ultrasound can be used as an indicator of vascular function preoperative vascular assessment.Age,systolic blood pressure,pulse pressure and serum creatinine levels are the major risk factors for brachial artery elasticity.The coexistence of multiple risk factors of hypertension,diabetes or chronic nephritis could exacerbate the decrease of brachial artery elasticity.