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>Duplex scanning-derived access volume flow: novel predictor of success following endovascular repair of failing or nonmaturing arteriovenous fistulae for hemodialysis.
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Duplex scanning-derived access volume flow: novel predictor of success following endovascular repair of failing or nonmaturing arteriovenous fistulae for hemodialysis.
The objective of this study was to evaluate the feasibility of duplex scanning-derived access volume flow (DAVQ) to predict the success or failure of arteriovenous fistulae (AVF) after interventions. Eighty-eight DAVQ measurements were available for 60 AVF in 59 patients. In 25 cases, physical examination findings or inadequate dialysis suggested failing (11) or nonmaturing (14) AVF. Outflow stenoses (1-4; mean 1.2 +/- 0.8) were confirmed by contrast fistulograms in 23 cases (17 peripheral; 6 central). These 23 cases underwent successful endovascular repair (17 balloon angioplasty; 6 stents) and had pre- and postintervention DAVQ measurements within 2 weeks of the procedure. Each was measured three times in a nontortuous venous segment with laminar flow, and mean values were used for comparison. The overall mean DAVQ for 65 functioning AVF was 1,199 +/- 485 mL/min, whereas it was 652 +/- 438 mL/min (range 150-1,840 mL/min) for the remaining 23 failing or nonmaturing cases (p < .0001). Postintervention, the latter values changed to 867 +/- 517 mL/min (range 257-2,020 mL/min), with a p < .13. Of these, 11 were still nonfunctional after endovascular procedures and had a mean DAVQ of 404 +/- 111 mL/min (range 257-652 mL/min). The remaining 12 cases had a mean DAVQ of 1,280 +/- 382 mL/min (range 762-2,020 mL/min) and were functional and usable for at least 6 months of follow-up (p < .0001). It is interesting to note that none of the AVF cases with postintervention DAVQ < 700 mL/min became functional and usable, whereas all cases with a higher DAVQ underwent successful hemodialysis treatments. This early experience suggests that DAVQ can be used to predict the success or failure of an AVF following endovascular procedures. To our knowledge, this is the first such report.
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机译：这项研究的目的是评估双向扫描衍生的访问量流量（DAVQ）预测干预后动静脉瘘（AVF）的成功或失败的可行性。 59位患者中有60位AVF可以使用88个DAVQ测量值。在25例中，体格检查结果或透析不足提示AVF失败（11）或未成熟（14）。通过造影瘘管图证实流出性狭窄（1-4;平均1.2 +/- 0.8）在23例（周围17例;中央6例）中得到证实。这23例患者进行了成功的血管内修复（17个球囊血管成形术; 6个支架），并在手术后2周内进行了干预前后的DAVQ测量。在具有层流的非曲折静脉段中分别测量三次，并使用平均值进行比较。 65个功能性AVF的总体平均DAVQ为1,199 +/- 485 mL / min，而其余23例失败或未成熟的病例的DAVQ为652 +/- 438 mL / min（范围150-1,840 mL / min）（p <。 0001）。干预后，后者值更改为867 +/- 517 mL / min（范围257-2,020 mL / min），p <.13。其中有11例在血管内手术后仍无功能，平均DAVQ为404 +/- 111 mL / min（范围257-652 mL / min）。其余12例平均DAVQ为1,280 +/- 382 mL / min（范围为762-2,020 mL / min），并且可以正常工作并且至少可以随访6个月（p <.0001）。有趣的是，干预后DAVQ <700 mL / min的所有AVF病例都没有功能和可用，而DAVQ较高的所有病例均成功进行了血液透析治疗。早期的经验表明，DAVQ可用于预测血管内手术后AVF的成功或失败。就我们所知，这是第一个此类报告。
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