Postoperatively Early Ultrasound Examination Predicting The Maturation Of Arteriovenous Fistula

Background:With the increasing number of patients with chronic kidney disease(CKD)in China,the demand for renal replacement therapy is expanding.More than 80% of patients with end-stage kidney disease received hemodialysis,and arteriovenous fistula became an ideal vascular access for hemodialysis treatment.With the prevelance of arteriovenous fistula,the problem of fistula maturity seriously limits the wide use of fistula.Early postoperative ultrasound examination could detect stenosis lesions affecting the maturation of fistula.Interventional treatment or surgery can help to improve the maturation rate of fistula,and reduce the mortality risk and the cost of complications related to the central venous catheter.Method:We recruited thirty-six patients with CKD5 who underwent arteriovenous fistula surgery in our department of nephrology from January 2019 to December 2019,and measured the relevant hemodynamic indexes preoperatively and at 1 day?2 weeks?6 weeks postoperatively by ultrasound,respectively.Fistula clinical maturity criterial: fistula cannulation with 2 needles and a dialysis machine blood pump speed of200 m L/min during 4 hours per one dialysis session,satisfying dialysis treatment at least 3 times per week.The patients were divided into the mature group and failure group according to whether met the clinical maturity criteria 6 weeks after the operation.Results:1? The maturation rate of arteriovenousl fistula was 77.8%.In the failure group,stenoses were found in 75% of patients,and all fistulas were assisted to mature after intervention.2? The inner diameter of cephalic vein,radial artery and brachial artery increased significantly in the mature group and the failure group.The cephalic vein diameter,radial artery diameter and brachial artery diameter were statistically significant at the adjacent time points between the two groups(P< 0.05).The cephalic vein diameter at the same time points between the two groups was only statistically significant at the 1 day and 6 weeks postoperatively,and there was no significant difference between radial artery diameter and brachial artery diameter at the same time points between the two groups.3? The blood flow of brachial artery increased significantly in mature group and failure group.Brachial arterial blood flow was statistically significant at the adjacent time points between the two groups(P<0.05).There was statistically significant at 2 weeks and 6 weeks postoperatively at the same time points between the two groups.The resistance index of brachial artery decreased significantly in both groups.Brachial artery resistance index was statistically significant at the adjacent time points in the two groups(P< 0.05).There was only statistically significant at the same time points between the two groups at 2 weeks and 6 weeks postoperatively.4? Brachial arterial blood flow at 1 day and 2 weeks postoperatively could be used to predict the maturation of fistula.The thresholds for predicting the maturation of fistula were 418ml/min and524.5ml/min,respectively.The prediction value of 2 weeks postoperatively was higher than 1 day postoperatively.5? The inner diameter of cephalic vein at 1 day and 2 weeks postoperatively could be used to predict the maturation of arteriovenous fistula.The thresholds for predicting the maturation offistula were 3.06 mm and 4.19 mm,respectively.The prediction value of 2 weeks postoperatively was higher than that of 1 day postoperatively.Conclusions: Ultrasound measurement of brachial artery blood flow and cephalic vein diameter can be used to predict the maturity of fistula at 1 day and 2 weeks postoperatively,and the value of prediction at 2 weeks postoperatively is better than that at 1 day postoperatively.