Study On The Value Of Color Doppler On The Arteriovenous Fistula

Objective:To discuss the value of color Doppler on AVF screening,follow-up and complication therapy screening of the ESRD patients.Methods:The experimental group:120 ESRD patients from Januay 2014 to September 2014 in our hospital underwent CDUS vessel examination.We screening operation patients according to the inner,path way,deepth and elastic of vessels and we followed up the successful AVF patients 3 days,2 weeks,2 months,3months after operation.The wall and cavity of AVF vessels were observed.The D,PSV,RI of radial artery,anastomosis,cephalic vein were measured.The control group:50 AVF ERSD patients had not been screening before operation from October 2013 to January 2014 in our hosipital underwent CDUS vessel examination.Among them,There are 10 artificial AVF whose operation mode were end to side anastomosis and 40 auto AVF whose operation mode included both end to end(28) and end to side anastomosis(12).The wall and cavity of AVF vessels were observed.The BABF and the stenoses diameter,PSV were measured.We defined AVF mature as its average dialysis flow achieved to 320 ml/min(280～350 ml/min) according to the clinical standard.Successful AVF patients were grouped in mature and immature group,the BABF and diameter of radial artery,anastomosis,cephalic(stenoses) vein were measured.Independent sample t test were used in each datas of mature and immature group.stenoses who were diagnosed by CDUS would undertake the CDUS guidance PTA,The BABF and the stenoses D,PSV were measured.Paired t test were used in each datas of preoperation and postoperation.Results:Among 120 patients,106 did the AVF successfully and 14 were failed.2 patients did the brachial-cephalic artificial AVF,12 did the jugular vein catheterization.The datas of 106 followed-up patients as follows:3d after operation:BABF 497±105 ml/min; D.PSV and RI of radial artery were:3.8±1.2 mm,154±93 cm/s;D of anastomosis 3.6±0.7 mm;D and PSV of cephalic vein were:4.5±0.7 mm,148±66 cm/s.2w after operation:BABF 594±139 ml/min; D,PSV and RI of radial artery were:4.2±1.0 mm,158±112 cm/s,0.35±0.09;D of anastomosis 4.0±0.9 mm;D and PSV of cephalic vein were:5.0±0.6 mm,157±87 cm/s.lm after operation:BABF 676±135 ml/min; D,PSV and RI of radial artery were:4.5±0.9 mm,165±91 cm/s,0.37±0.12;D of anastomosis 4.1±1.0 mm;D and PSV of cephalic vein were:5.1±0.9 mm,154±92 cm/s.2m after operation:BABF 680±155 ml/min;D,PSV and RI of radial artery were:4.7±0.9 mm,150±78 cm/s,0.42±0.08;D of anastomosis 4.2±1.1 mm;D and PSV of cephalic vein were:5.2±1.0 mm,167±109 cm/s.3m after operation:BABF 674±141 ml/min; D,PSV and RI of radial artery were:4.7±1.2 mm,189±120 cm/s,0.40±0.05;D of anastomosis 4.1±1.2 mm;D and PSV of cephalic vein were:5.7±1.2 mm,150±66 cm/s.In 3 months,12 were found comlication in the experience group while 18 were found in the control group by CDUS.In the experience group,stenoses were 6,stenoses with thromb were 2,hematoma were 2,occlusion were 1,phlebitis were l.In the control group,stenoses were 12,stenoses with thromb were 5,occlusion were 1.Others AVF and hemodialysis were normal.The chi square test were used in the incidence of complication of 2 groups,the P value was 0.00026,the difference had statistical significance.In the control group,the mature AVF was 100 and immature AVF was 6 according to the clinical standard.Among the mature group,the datas were as follows:BABF 631 ±117 ml/min;D of radial artery 5.2±0.6 mm;D of anastomosis:3.2±0.4 mm;D of cephalic vein:5.6±0.3 mm.In the control group:the datas were as follows:BABF 161±46 ml/min;D of radial artery3.1±0.4 mm;D of anastomosis:2.5±0.3 mm;D of cephalic vein:2.3±0.5 mm.All of the P value of each datas in matures and immatures were< 0.05, the difference had statistical significance.25 stenoses patients were underwent the CDUS guidance PTA,before the PTA,the D,PSV,BABF were 1.3±0.33 mm,551±96cm/s,168±64 ml/min;after the PTA,the D,PSV,BABF were 3.1±0.4 mm,220±29 cm/s,434±107 ml/min.The paired t test were used in the datas before and after the PTA,the P value of each group were< 0.05,the difference had statistical significance.Among the 25 patients,23 could dialyze normally,2 could not.Conclusion:CDUS screening vessels before AVF construction can reduce the incidence rate of complicaton;CDUS measuring BABF,D of radial artery,anastomosis,cephalic vein has its value in forecasting complication;CDUS can discover the complication timely;CDUS guidance PTA is an effective way to cure the AVF stenoses.