Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

Abstract Background Adequate flow through a newly created arteriovenous fistula depends on multiple characteristics of the vessels and patient comorbidities. Several studies have related preoperative findings to failure, but few have analyzed the influence of intraoperative findings. Objectives To evaluate the predictive value of intraoperative findings on the immediate outcome of radial-cephalic arteriovenous wrist fistulas (RCAVF) by collecting data that are easily measured intraoperatively. Methods We designed a cross-sectional study, in which a single surgeon performed 101 RCAVF in 100 patients at a single center. We analyzed the immediate postoperative flow, assessed by thrill intensity immediately after fistula creation, against patient demographics and intraoperative data. The following variables were analyzed: age, sex, comorbidities, length of vein visible at preoperative examination, macroscopic arterial calcification, maximum vein diameter, and length of stenosis-free vein, measured by cannulation with a urethral catheter during the procedure. The chi-square test was used both to eliminate possible bias introduced by side of venous access (left or right), and to determine predictive values of immediate thrill. Results Side of access was not associated with any significant differences in variables. Absence of macroscopic arterial calcification, successful venous catheterization using a 6 French catheter or larger, and ability to advance it more than 10 centimeters along the lumen of the proximal vein were correlated with adequate immediate postoperative thrill (p = 0.004, p < 0.001, and p = 0.005, respectively). Conclusions In this series of 101 RCAVF, both the diameter of the catheter and its progress through the proximal vein and also absence of arterial calcification had positive predictive value for achieving adequate immediate thrill after vascular access construction.

【摘要】
背景：新建动静脉瘘的通畅性取决于血管的多项特征及患者合并症。既往多项研究将术前检查结果与瘘管失败风险相关联，但鲜有分析术中探查结果的影响。
目的：本研究旨在通过收集术中易于测量的数据，评估术中探查结果对桡头型腕部动静脉瘘（radial-cephalic arteriovenous wrist fistulas, RCAVF）即刻通畅效果的预测价值。
方法：本研究为单中心横断面研究，由同一名外科医师在单中心为100例患者实施101例RCAVF手术。我们以术后即刻震颤强度评估瘘管即刻通畅性，并将其与患者人口统计学资料及术中数据进行关联分析。本次分析纳入的变量包括：年龄、性别、合并症、术前检查可见的静脉长度、肉眼可见动脉钙化情况、最大静脉直径，以及术中通过导尿管插管测量的无狭窄静脉段长度。采用卡方检验消除静脉通路侧别（左侧或右侧）带来的偏倚，并评估即刻震颤的预测价值。
结果：静脉通路侧别与各项变量均无显著差异。无肉眼可见动脉钙化、使用6F（6 French）导管成功完成静脉插管，以及导尿管沿近端静脉管腔推进超过10cm，均与术后即刻良好震颤显著相关（分别为p=0.004、p<0.001、p=0.005）。
结论：在本项纳入101例RCAVF手术的队列中，导尿管型号、导尿管通过近端静脉的推进程度，以及无动脉钙化情况，均对血管通路构建后获得良好即刻震颤具有正向预测价值。