The Application Value Of Vascular Ultrasound In Evaluating The Influencing Factors Of Venous Aneurysmal Dilatation Of Drainage Vein In Hemodialysis Patients

Objective: Maintenance hemodialysis(MHD)is the most common method of renal replacement therapy.Autogenous arteriovenous fistulas(AVF)has the advantages of low incidence of complications,good patency,and long service life,which is the first choice of MHD.Venous aneurysmal dilatation(VAD)can lead to skin infection,thrombosis,and the risk of bleeding after rupture in severe cases,which can lead to AVF failure.At present,there are few studies on the influencing factors of VAD.This study aims to evaluate the influencing factors of VAD in patients with AVF by vascular ultrasound,and to find non-invasive vascular ultrasound indicators with diagnostic value for VAD patients,to effectively prevent AVF dysfunction and prolong the service life of vascular access.Method: A total of 43 AVF patients in the dialysis center of our hospital were enrolled.General clinical data and medical history were collected.The Super Sonic Imagine Aix Plorer ultrasonic diagnostic system was used to perform vascular ultrasound examination on all subjects who met the inclusion criteria.According to the research of Balaz et al.,the subjects were divided into no venous aneurysm dilatation group(NVAD)and venous aneurysm dilatation group(VAD).1.General clinical data and methodsGeneral clinical data and medical history of patients were collected,blood samples were collected and analyzed in the early morning of the dialysis day,and biochemical test results of calcium,phosphorus,calcium-phosphorus product,parathyroid hormone,serum urea,creatinine,etc.,and dialysis parameters were recorded on the dialysis day.2.Vascular ultrasound: On the day of dialysis,the upper limb vessels were detected by ultrasound before dialysis,and the vascular ultrasound parameters such as anastomotic stoma(AS),cephalic vein(CV),radial artery(RA)and brachial artery(BA)on the AVF side were collected.Conventional vascular ultrasound parameters: D,PSV,MDV,EDV,PI,RI,VTI,VF,DVd,VADd,and Dist.Results: 1.MHD patients grouped results: A total of 43 MHD patients were enrolled.There were 20 patients in the non-venous aneurysm dilatation group,accounting for47.0% of AVF patients,including 9 males(45.0%).There were 23 patients in the venous aneurysmal dilatation group,accounting for 53.0% of AVF patients,including14 males(61.1%).2.Comparison of venous aneurysmal dilatation group and non-venous aneurysmal dilatation group.(1)Comparison of general clinical data: Compared with NVAD patients,VAD patients had a longer dialysis age,and the difference was statistically significant(P < 0.05).(2)Comparison of biochemical indicators: Compared with NVAD patients,the level of hemoglobin in VAD patients was lower,and the difference was statistically significant(P < 0.05).(3)Comparison of vascular ultrasound parameters: Compared with the NVAD group,CVVTI,RAVF and BAD in the VAD group were larger;ASVTI,BAPI and BARI were smaller in VAD group(P < 0.05).3.Correlation analysis: DVd was positively correlated with dialysis age and serum calcium level(r=0.392,P=0.009;r=0.319,P=0.037).DVd was positively correlated with CVPSV,CVMDV,CVEDV、CVVTI and CVVF(r=0.409,P=0.007;r=0.430,P=0.004;r=0.033,P=0.031;r=0.370,P=0.015;r=0.311,P=0.042).DVd was positively correlated with RAPSV,RAEDV,RAVTI and RAVF(r=0.352,P=0.021;r=0.400,P=0.009;r=0.347,P=0.022;r=0.552,P<0.001).DVd was positively correlated with BAD,BAEDV and BAVF(r=0.465,P=0.002;r=0.310,P=0.043;r=0.303,P=0.049).DVd was negatively correlated with BARI and BAPI(r=-0.371,P=0.014;r=-0.428,P=0.004).The results were statistically significant(P<0.05).4.Univariate and multivariate Logistic regression analysis: Univariate analysis showed that there were statistically significant differences in dialysis age,CVVTI,RAVF,BAD,BARI and BAPI between VAD group and NVAD group(P<0.05).Multivariate regression analysis showed that dialysis age(OR=1.386,95%CI: 1.065-1.829,P=0.016),RAVF(OR=1.004,95%CI: 1.001-1.007,P=0.022)and CVVTI(OR=1.050,95%CI: 1.007-1.096,P=0.022)were the risk factors for VAD(P <0.05).5.ROC curve analysis: Dialysis age,RAVF and CVVTI could evaluate whether VAD occurred in AVF patients(AUC: 0.695,95%CI: 0.355-0.826,P=0.017;AUC: 0.711,95%CI: 0.553-0.839,P=0.008;AUC: 0.817,95%CI: 0.670-0.918,P < 0.001;AUC:0.896,95%CI: 0.764-0.968,P < 0.001).The combined model of dialysis age,RAVF and CVVTI has a good diagnostic efficacy for VAD.Conclusions: 1.Compared with the NVAD group,the VAD group had a longer dialysis duration,and dialysis duration was positively correlated with DVd.2.DVd was positively correlated with CVVF,RAVF and BAVF.The larger the VF of AVF drainage vein and feeding artery,the more obvious the increase of DVd.3.Dialysis age,RAVF and CVVTI are the risk factors for VAD.4.The combined model of dialysis age,RAVF and CVVTI has a good diagnostic efficacy for VAD.