影响自体桡动脉头静脉瘘成熟的因素

Abstract

目的: 探讨影响自体桡动脉头静脉瘘（RCAVF）成熟的因素，尤其是术前血管直径和动静脉瘘成熟的关系。

方法: 回顾性分析香港大学深圳医院2013年6月至2019年5月接受RCAVF手术的患者资料。共有280例患者（女性105例，37.5%）纳入该项研究，年龄为（56.6±14.8）岁。桡动脉和头静脉的直径分别为（2.3±0.5）mm （范围：1.5~4.0 mm）和（2.4±0.6）mm （范围：1.5~4.3 mm）。术前常规行动脉和静脉彩超标记并测量血管直径。根据患者动静脉瘘功能性成熟情况分为两组，对比分析两组之间在年龄、性别、术前静脉和动脉直径、糖尿病、冠心病、周围血管疾病、吸烟以及抗血小板治疗方面有无差异。

结果: 238例（238/280, 85.0%）RCAVF达到功能性成熟。成熟组和未成熟组在年龄、合并冠心病、合并糖尿病、吸烟以及抗血小板治疗方面差异无统计学意义（P均>0.05）。相较于成熟组，未成熟组的桡动脉[（2.1±0.4）mm比（2.4±0.5）mm, t=3.858，P<0.001）]和头静脉直径[（2.0±0.5）mm比（2.4±0.5）mm, t=5.019，P<0.001）]较小。女性患者（34.4%比54.7%，χ2=6.282，P=0.015）、合并有周围动脉疾病（8.8%比21.4%, χ2=5.929，P=0.026）也是动静脉瘘未能成熟的影响因素。当桡动脉直径大于2.05 mm（92%比74%, P<0.01），头静脉直径大于1.85 mm （93%比53%, P<0.01）时,动静脉瘘成熟率显著增加。

结论: 术前血管直径是影响动静脉瘘成熟的主要因素，适合动静脉造瘘的最小桡动脉和头静脉直径分别为2.05 mm和1.85 mm。女性、合并有周围动脉疾病也是影响动静脉瘘成熟的危险因素。

Objective: To investigate the predictors of autogenous radiocephalic arteriovenous fistula (RCAVF) maturation, especially the correlation between preoperative vessel diameter and AVF maturation outcome.

Methods: The data of 280 patients undergoing RCAVF creation from June 2013 to May 2019 were analyzed retrospectively. Preoperative assessment of vessel diameter and duplex ultrasound mapping were routinely performed. The patients were allocated to two groups according to functional maturation outcome. Comparison of the variables between the matured and non-matured group was performed, including age, sex, vein and artery diameter, diabetes, coronary arterial disease (CAD) , peripheral arterial disease (PAD) , smoking and antiplatelet treatment.

Results: A total of 280 patients (female 105, 37.5%) with a age of (56.6 ± 14.8) years old were included in this study. The diameter of radial artery and cephalic vein were (2.3±0.5) mm (range: 1.5-4.0 mm) and (2.4± 0.6) mm (range: 1.5-4.3 mm) , respectively. Primary functional maturation was achieved in 238 patients (238/280, 85.0%) . There was no statistical significance between the matured and non-matured group in terms of age, CAD, diabetes mellitus, smoking or antiplatelet therapy. However, the radial artery [ (2.1±0.4) mm vs (2.4±0.5) mm, t=3.858, P<0.001) ] and the cephalic vein diameter [ (2.0±0.5) mm vs (2.4±0.5) mm, t=5.019, P<0.001], female gender (34.4% vs 54.7%, χ2=6.282, P=0.015) , and presence of PAD (8.8% vs 21.4%, χ2=5.929, P=0.026) were associated with the failure of maturation. The rate of AVF maturation increased significantly when the radial artery was larger than 2.05 mm and cephalic vein larger than 1.85 mm.

Conclusions: In this study, vein and artery diameters on preoperative ultrasound mapping are the predictors of functional maturation. The best cutoff diameter for radial artery and cephalic vein are 2.05 mm and 1.85 mm, respectively. Female gender and presence of PAD are associated with failure of maturation.