目的 探讨纤细动脉建立自体动静脉内瘘(arteriovenous fistula,AVF)后成熟率及通畅率，并基于血管重构理论分析影响AVF成熟的相关因素。方法 选择手术前桡动脉内径≤1.5 mm的AVF患者，超声测量手术前桡动脉及头静脉血管内径，手术后1月测量头静脉内径、肱动脉内径及血流量，评估成熟并随访12个月，分析纤细血管建立AVF的预后。 结果 56例患者纳入研究，手术前平均桡动脉内径(1.26±0.28)mm，束臂后平均头静脉内径(2.72±0.53)mm，最细桡动脉内径0.5 mm。40例(71.43%)患者AVF未经干预自然发育成熟，其余16例患者中，13例(23.21%)经腔内手术或外科重建干预后成熟。回归模型显示:手术前桡动脉内径是AVF成熟预测的独立相关因素，预测AVF成熟的最佳临界值为桡动脉内径＞1.35 mm。56例患者平均随访(11.39±5.81)月，手术后3月，6月，12月初级通畅率分别为73.08%，68.75%，65.71%；3月，6月，12月次级通畅率分别为100%，97.92%，100%。 结论 手术前桡动脉内径≤1.5 mm的纤细桡动脉构建的AVF可具有较高的成熟率及远期通畅率，桡动脉内径1.35 mm以上有较大概率自然发育成熟。
杨艳丽
,
徐元恺
,
户培华
,
李文
,
刘永亮
,
孙利军
,
任广伟
,
牛哲莉
,
张晶
,
阮琳
,
张丽红
. 基于血管重构的纤细动脉自体动静脉内瘘成熟影响因素分析[J]. 中国血液净化, 2024
, 23(04)
: 298
-301,316
.
DOI: 10.3969/j.issn.1671-4091.2024.04.013
Objective To investigate the maturation and long-term patency of arteriovenous fistula (AVF) constructed by slender artery, and to analyze the influencing factors for maturation of the AVF based on the theory of vascular remodeling. Method Patients undergoing AVF operation using the radial artery diameter ≤1.5 mm for the construction were selected. The diameters of radial artery and cephalic vein were measured by ultrasound before operation; Blood flow and diameters of cephalic vein and brachial artery were measured after operation for one month. The maturation of AVF was evaluated and follow-up study was conducted for 12 months to analyze the prognosis of AVF established by slender vessels. Result Fifty-six patients were included in this study. Before operation, the mean diameter of radial artery was 1.26±0.28 mm, and the smallest diameter of radial artery was 0.5 mm; the average diameter of the cephalic vein after dilatation by tourniquet was 2.72±0.53 mm. AFV maturation progressed naturally without intervention in 40 patients (71.43%), and the AVF maturated after endovascular surgery or surgical reconstruction in 13 (23.21%) of the remaining 16 patients. Regression model showed that radial artery diameter was an independent factor for predicting AVF maturation, and the best critical value for predicting AVF maturation was radial artery diameter ＞1.35 mm. The average follow-up time of the 56 patients was 11.39±5.81 months. After the operation for 3, 6 and 12 months, the primary patency rates were 73.08%, 68.75% and 65.71% respectively and the secondary patency rates were 100%, 97.92% and 100% respectively. Conclusions AVF constructed by slender radial artery has a high maturity rate and long-term patency rate. The radial artery diameter over 1.35mm is more likely to mature naturally.
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