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背景 新建动静脉瘘（arteriovenous fistula）的通畅血流，取决于血管自身的多项特征及患者的合并症状况。已有多项研究将术前检查结果与瘘管失败相关联，但鲜有研究分析术中发现的影响。 研究目的 本研究旨在通过收集术中易于测量的数据，评估术中发现对桡头静脉腕部动静脉瘘（radial-cephalic arteriovenous wrist fistulas, RCAVF）即刻预后的预测价值。 方法 本研究为横断面研究，由同一位外科医师在单中心为100例患者完成101例RCAVF手术。我们以术后即刻震颤强度评估术后即刻血流情况，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长度。本研究采用卡方检验，以消除静脉通路侧别（左侧或右侧）带来的潜在偏倚，并确定即刻震颤的预测价值。 结果 静脉通路侧别与各变量间均无显著差异。无肉眼可见动脉钙化、使用6F导管或更大尺寸导管成功完成静脉插管、以及能将导管沿近端静脉管腔推进超过10厘米，均与术后即刻良好震颤达标相关（p = 0.004, p