| Vascular access is the " living-line" to chronic hemodialysis patients. The native radio - cephalic fistula ( RCF) , created by surgical anastomosis of the cephalic vein to the radial artery in the wrist, was first described by Brescia in 1966. RCF was the preferred access as its higher patency and lower thrombosis prevalence. But many factors could affect vascular selection and maturation. Physical and invasive measurements were used to assess vascular access. In this study, color Doppler ultrasound as noninvasive method pre - operative for best fistulas sites by means of radial artery and cephalic vein, success rate and maturation was evaluated post-operatively after hemodynamic parameters obtained.Materials and methods1. ObjectivesSixty-eight chronic renal failure patients planned to create new permanent vascular access between April 2003 and march 2004. The patients consist of 32 men and 3 6 women , ranging in age from 1 8 to 8 2 years with a mean age of 51.2y. 33 patients accepted ultrasound examination (examined group) randomly , while other 35 only measured by physical examination ( contrasted group). 6 of 11 Type 2 Diabetes Mellitus (DM) patients accepted ultrasound examination. Operative type was radio-cephalic end-to-lateral anastomosis on wrist of left or right arm.2. MethodsAll the ultrasound investigations were performed with a 7 ~ 10 MHz linear-probe ( HP-Hewlett Packard Image Point Hx).The ultrasound observation parameters including diameter of radial artery and cephalic vein, peak systolic velocity ( PSV), end-diastolic velocity ( EDV) , mean velocity (MV) ,pulse and resistance index (PI, RI) and volume flow of radial artery. Ultrasound exams were performed pre-operatively , 1 week and 6 months post-operatively, respectively.Pulse-touching and Allen's test were performed as regular physical exam. Diameter more than 1.5 mm of both radial artery and cephalic vein was considered suitable for operation. Access flow during hemodialysis reached 200 ~ 300ml/min and radial artery volume flow over 300ml/min were criteria of RCF success. Failure was defined as thrombosis completely or stenosis seriously (stenosis rate of access vascular diameter >75% ).3. Statistical analysisAll continuous varieties were described by mean value ?standard error. All success RCF flow parameters were performed by paired t-test between pre-operative and 1 week post-operative, 1 week and 6 months post-operative. Parameters between DM and NDM group 1 week and 6 months post-operative used un-paired t-test. All tests of significance were two-sided, and differences were considered statistically significant when the p value <0.05. The above statistical analysis were conducted with the statistical software package SPSS for Windows, version 11.5.Results1. Comparison between examined and contrasted group of operative success rate:31 of 33 in examined group was operated, 3 failed post-operatively, the total success rate is 90. 3%. In contrasted group ,7 of 35 was failed , the total success rate is 80% .2. Comparison of pre-and post-operative ultrasound parameters of RCF: Differences of parameters between pre-operative and 1 week post-operativewere statically significant. Volume flow and diameter of cephalic vein increased statically significantly between 1 week and 6 months post - operative.3. Characteristic of Doppler and blood flow of radial artery pre-and post-op-erativeStable flow and high RI was the characteristic of radial artery pre-operative. High velocity and low RI like whirling flow was the characteristic of RCF success group. Characteristic of RCF failure group was of high RI like the pre-operative.4. Comparison of parameters between DM and NDM group:PI and RI increased significantly 1 week and 6 months post-operative, while RAD decreased significantly 6 months post-operative compared between DM and NDM group.ConclusionsIn the study, we can conclude that (1) Examinations on radial artery and cephalic vein pre-operative could improve success rate and avoid loss o... |
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