| Objective:To investigate the feasibility and application value of non-enhanced MRA(NCE-MRA)in evaluating autologous brachial artery-cephalic fistula in hemodialysis patients.Method:(1)From September in 2017 to February in 2019,a total of 118 patients,aged30-64 years,who underwent autologous brachial artery-cephalic fistula surgery in the First Central Hospital of Tianjin.All patients were operated by the same surgeon,ranging from two months to one year duration of dialysis.All vascular access was located on the left elbow.Informed consent was obtained from all patients.All patients underwent NCE-MRA,and 20 of them underwent ultrasound at the same time.NCE-MRA and ultrasonography were performed to observe the presence of arterial stenosis,sclerosis,and patency of the cephalic vein;the diameter,cross-sectional area,and flow of the radial artery and cephalic vein were measured.The normal distribution of the radial artery,cephalic vein inner diameter,cross-sectional area and flow were tested.The intra-class correlation coefficient(ICC)was used to analyze the consistency of the measurements between the two observers.Differences between two different methods in 20 patients were compared using paired t-test or rank sum test.Correlation between internal diameter,cross-sectional area,and radial artery flow was compared using Pearson or Spearman correlation analysis.(2)From October 2017 to December 2018,a total of 34 patients,aged 30-64 years,who underwent autologous brachial artery-cephalic fistula surgery at the First Central Hospital of Tianjin.All patients were performed by the same surgeon.All vascular access is located on the left elbow.Informed consent was obtained from all patients.The cross-sectional area of the radial artery,brachial artery,cephalic vein,blood flow,ulnar artery cross-sectional area,and cephalic vein minimum diameter,intima thickness and depth of skin was measured 1 day before and after surgery(2 weeks,5weeks,8 weeks,6 months,one year).One-way analysis of variance or nonparametric test was used to analyze the difference between brachial artery,radial artery,ulnar artery,cephalic vein,anastomotic cross-sectional area,radial artery,cephalic vein,radial artery flow,cephalic intima thickness,depth of skin,relevant indicators of the laboratory before and after the operation.Multiple linear regression was used to analyze the influencing factors of changes in cephalic vein flow of patients.Result:(1)under ultrasound technique,the results of two observers showed that the radial diameter,cross-sectional area,flow and cephalic vein flow were good consistency,and the diameter and cross-sectional area of the cephalic vein were medium consistency,ICC value was 0.76?0.84?0.98?0.90?0.61?0.63 respectively.Under NCE-MRA,the results of two observers showed that the radial artery,cephalic vein inner diameter,cross-sectional area,and flow consistency were good consistency,ICC value was 0.89,0.87,0.87,0.91,0.91,0.95 respectively.And the most consistency between the two observers was the values of radial artery and cephalic vein flow.(2)Under two techniques:There were significant different between the grops of the radial artery,cephalic vein diameter,and cross-sectional area(P<0.001);there were no significant difference between the grop of the radial artery and cephalic vein flow(P>0.05).The radial artery diameter,cross-sectional area and radial artery blood flow and cephalic vein internal diameter,cross-sectional area were significantly positively correlated with cephalic venous blood flow(P<0.001);and the correlation between blood flow and cross-sectional area was stronger than Correlation between diameters.(3)There is a linear correlation between the cross-sectional area of the radial artery and blood flow.The cross-sectional area of the cephalic vein and the blood flow and the diameter of the radial artery and cephalic vein and the blood flow tend to be power-dependent.(4)The follow-up of 34 patients showed that there were significant differences between the brachial artery,the radial artery,the cephalic vein cross-sectional area and flow before and after surgery(P<0.001).There were significant difference in the anastomotic cross-sectional area between the groups after surgery(P<0.001).There was no significant difference in the cross-sectional area of the ulnar artery,the minimum internal diameter of the cephalic vein,the depth of the cephalic vein,and the laboratory index between the patients before and after surgery(P>0.05).(5)34 patients were followed up:the minimum diameter of cephalic vein was positively correlated with the radial artery,radial artery,ulnar artery,cephalic vein,anastomotic cross-sectional area,radial artery,radial artery and cephalic blood flow.(P<0.05).(6)Age(?-0.70,95%CI:-6.52~-24.97,P=0.003)and central venous catheterization or not(?-0.47,95%CI:-419.78~-28.52,P=0.029)are independent factors of the cephalic vein flow changes.Conclusion:(1)NCE-MRA is an effective evaluation of arteriovenous brachial artery-cephalic fistula,and it can be objectively measured for diameter,cross-sectional area,flow.And the evaluation of fistula can be based on cross-sectional area and blood flow.(2)NCE-MRA can objectively,non-invasively and dynamically display the access status of hemodialysis patients.The cross-sectional area of vessels and hemodynamic changes have certain reference value for predicting hemorrhoid function,it can prompt early clinical intervention according to hemodynamic changes,prolong the use of internal hemorrhoids,and improve the quality of life of hemodialysis patients.(3)In clinical,the blood flow can be estimated to the cross-sectional area,which provides a reference for clinical evaluation of access status.(4)The cross-sectional area of the cephalic vein>19.625mm~2 and the cephalic vein flow>500 mL/min can be used as the standard for the maturation of the autologous brachial artery-cephalic fistula.(5)The age and the central venous catheterization were the influencing factors of the change of the cephalic vein flow from 8 weeks to 6 months after operation. |
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