| Objective: Vascular access is the lifeline of hemodialysis patients. Nativearteriovenous fistula (AVF) represents the best vascular approach for chronichemodialysis, due to arteriovenous fistula has the advantages of long life andfewer complications. It has reached a consensus in the international. But forthe mature time of autologous arteriovenous fistula have no unified standard.The generally accepted mature concept is achieving enough dialysis bloodflow and having no leakage when in the cannulation fistula. But need to proofthat fistula is mature or not after the cannulation. Today, there is not an easymethod to validate the mature of the fistula in addition to cannulation fistula.2006Dialysis Outcomes Quality Initiative (DOQI) recommends that fistulashould mature for at least one month before annulation, best after6-8weeks.Reported in the literature, puncturing the fistula in2-4weeks after establishthe fistula, which do not increase the risk of fistula dysfunction. They believethat it have no relation between the fistula maturity and the first cannulationtime of the fistula. The research of fistula maturation conditions and time isrelatively scarce in China. The purpose of this study is evaluating the naturalprocess of fistula mature by color doppler ultrasound and physicalexamination; studying the fistula cannulation timing for the first time;discussing the fistula mature conditions initial; analyzing the influencingfactors of fistula mature opportunity.Methods: Prospective observational data were analyzed for sample(N=37) of End stage renal disease patients in Third Hospital of Hebei MedicalUniversity From October2010to September2011.To record the patient'sgeneral situation and the primary disease. The doctor determine which side ofthe upper limb could do angioplasty of arteriovenous fistula.by physicaexamination before surgery, By color doppler ultrasound to check the forearm vascular that would be surgery, and to record radial artery diameter, bloodflow, the inner diameter of the cephalic vein. The only doctor did theangioplasty of arteriovenous fistula from Third Hospital of Hebei MedicalUniversity Department of Nephrology. At the1day,1week,2weeks,4weeksto do the color doppler ultrasound examination, record of the diameter, andblood flow of radial artery and cephalic vein every time. The fixed nurseobserved the process of fistula growth through physical examination. Thefixed nurses with experience of hemodialysis centers by physical examinationbelieve that the fistula can be punctured, to do color doppler ultrasonographyfor fistula. The mature fistula had long segment of available for puncture ofblood vessels, and it was naturally straight and uniform thickness.The maturefistula had no tortuous and no collapse, and the fistula anastomotic and bodysegment can be touched the thrill. The bruit of mature fistula was pairs,low-pitched and continued. The nurses believed the fistulas meet the abovestandards that can be punctured. The experimenters recorded the time,cephalic vein wall thickness, diameter, and blood flow of radial artery andcephalic vein. The fixed nurse punctured fistula for hemodialysis, in order todetermine the maturity of fistula. To do the color doppler ultrasound again torecord the above indicators when fistula mature really, such as fistula can notused in hemodialysis. After the end of dialysis, the pin was removed, to stopbleeding by the regular doctor. The experimenters reviewed the fistula byColor Doppler ultrasound including the cephalic vein wall thickness, diameterand blood flow of radial artery and cephalicvein. Statistical analysis wascarried out with the SPSS17.0software. A p value of <0.05was considered assignificantResults:37patients,30cases of fistula mature,5cases were lost tofollow,2cases failure to mature. We studied30Patients with mature fistula,mean age52.80±13.37years,18male (60%) and12females (40%). Meancannulation time was58.86±17.03days, When fistula has matured, cephalicvein flow was593.07±257.25ml/min, the cephalic vein diameter was4.83(1.11) mm. cephalic vein wall thickness was0.97±0.21mm, radial artery diameter was3.97(1.03) mm, radial artery flow was463.45(246.90) ml/min.No association was found between cannulation≤42days versus＞42days forcephalic vein diameter (z=-0.882, P=0.378), cephalic vein flow (t=0.789, p=0.450), the cephalic vein wall thickness (t=-0.280, p=0.782), radial arterydiameter (t=-0.876, p=0.389), radial artery flow (z=-0.249, p=0.803). Noassociation was found between4weeks group versus mature fistula group forradial artery diameter (z=-0.190,P=0.850), radial artery flow (z=-0.356,P=0.722), cephalic vein diameter (z=-0.720,P=0.471), cephalic vein flow(z=-0.743,P=0.457), No association was found between fistula maturity6months group versus mature fistula group for radial artery diameter(z=-0.172,P=0.864), radial artery flow (z=-0.212,P=0.832), cephalic veinflow (z=-1.216P=0.224). Significantly different was found between the twogroups for cephalic vein diameter (z=-2.936, P=0.003), cephalic vein wallthickness (t=-6.149, p=0.000), the cephalic vein diameter and wall thicknessincreased significantly than the fistula mature. No association was foundbetween cannulation≤42days versus＞42days for patient characteristics ofgende(rp=0.249), Albumin(z=-1.041,p=0.298), serum creatinine(t=1.927,p=0.064), Hemoglobin(z=-1.878,p=0.060). In≤42days mean age43.89±14.40years,＞42days mean age56.62±11.13years. The fistulamaturation time of younger patients earlier than olders (t=-2.629, p=0.014).In≤42days, without diabetes patients accounted for11.11%;>42days,without diabetic patients accounted for47.37%. the fistula mature time ofwithout diabetes patients earlier than diabetes patients (p=0.042).Conclusion:1. The time factor is not regarded as an absolute indicator of a fistula matureand fistula vein diameter and blood flow is regarded as relatively stableindicators. That is, when the cephalic vein inside diameter is up to4.83(1.11)mm, head blood flow is of593.07±257.25ml/min and the cephalic vein wallthickness is of0.97±0.21mm, combined the results of physical examination,the fistula is mature to be punctured. It takes a certain time (at least more than4weeks). 2. As to our patients, the arteriovenous fistula cephalic vein diameter is able tomature without the need to reach6mm.3. It takes at least4weeks after the establishment of the fistula in order toachieve a level of maturity and after this it also need to wait at least fourweeks to start puncture fistula.4. The production of autologous arteriovenous fistula should be at least onemonth in advance to end-stage renal disease that required hemodialysispatients and preferably more than three months before to senior citizens andthose with diabetes and other high-risk patients.5. The fistula maturation time is longer to patients who is suffering fromdiabetes or older. So the general condition and blood vessel conditions shouldbe assessed as soon as possible and the autologous arteriovenous fistula shouldbe produced earlier. |
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