| Background:Autologous arteriovenous fistula(AVF)is the best choice for vascular access in maintenance hemodialysis patients,and the timing of the first cannulation after maturity varies in different regions.The consensus of vascular access experts in China suggests that the best timing of fistula cannulation is 8-12 weeks after surgery,and the cannulation is feasible after 4 weeks,and the trocar is used to be extended to 2-3 weeks.The 2006 K/DOQI guidelines recommend 6-8 weeks;The European vascular access guidelines recommend use after 4 weeks,while the Japanese hemodialysis guidelines suggest that cannulation can be done safely after 2 weeks of AVF establishment.In China due to factors such as economic difficulties or exclude hemodialysis,quite a number of patients diagnosis with end-stage kidney disease can’t use fistula as the first choice for hemodialysis,.Center venous catheter widely used as a transitional method,easily occur in the incidence of complications such as infection,hemorrhage,vascular stenosis and longer duration of catheter and heighten affect survival time and quality.Objective:In this study,ultrasound at different time periods was used to evaluate the maturation progression after fistula creation,accurately guide the appropriate time of fistula puncture,and then carry out fistula puncture more effectively,and remove temporary centre vein catheterization in time,so as to avoid or reduce the occurrence of the above complications and benefit the patients.Methods:A follow-up study was conducted on 56 patients with end-stage renal disease who had indications for hemodialysis and were willing to establish AVF on the upper limb and forearm in Northern Jiangsu People`s Hospital from January 2019 to January 2020.Patients’ baseline data were recorded,radial artery diameters,cephalic vein diameter;brachial artery diameter,blood flow and resistance index of brachial artery were recorded preoperatively and at 1d,1w,2w,3w,4w,and 6 weeks after surgery.Autogenous arteriovenous fistuloplasty was performed by the same surgeon.Postoperative first cannulation time(FCT)for dialysis can be considered after clinical physical examination by experienced doctors and nurses in the hemodialysis room,and meet the standard of brachial artery blood flow > 500ml/min,cephalic vein >4mm,and the subcutaneous depth of the puncture vessel < 6mm.The fistula was identified as mature after successful puncture,sufficient dialysis blood flow,no obvious hematoma after puncture,and regular dialysis for 3 times a week.The patency,frequency of dialysis,stenosis,intervention measures and complications of AVF within 1 year after cannulation were recorded.according to the maturity of internal fistula,it was divided into mature group and failure group.The mature group was divided into early puncture group and late puncture group according to puncture time.Statistical analysis was performed using SPSS22.0.Results:1.Among the 56 surgical patients,46 cases of fistula were mature,10 cases were immature,and the natural maturation rate was 82.1%.8 of the 10 cases matured after surgical intervention,and the assisted maturation rate was 96.4%.After intervention,1 failed case establish long-term central venous catheter for hemodialysis,and another failed case succeeded in dialysis after establishment of contralateral arm AVF.2.There were no significant differences in preoperative baseline data and vascular parameters between the mature group(46)and the failure group(10).The brachial arterial blood flow,brachial arterial RI and cephalic vein diameter were statistically different between the two groups at 1 day and each monitoring time after surgery.The brachial artery blood flow,brachial artery resistance index and cephalic vein diameter in the mature group showed statistically significant differences in the adjacent time of 1 day,1 week and 2 weeks after surgery,and these indexes changed rapidly within 2 weeks.3.Brachial artery flow and cephalic vein diameter at 1 day,1 week and 2 weeks postoperatively could predict the maturity of fistula,and the prediction effect was the best at 1 week postoperatively.Brachial artery flow r> 305ml/min and cephalic vein diamete > 3.70 mm at 1 week postoperatively could predict the maturity of long-term AVF.The brachial artery RI can be used for early prediction of AVF failure at 1day and 1 week after the operation,and the prediction value is the highest at 1 day after the operation,suggesting that the brachial artery RI > 0.635 on 1 day after the operation,and the risk of immaturity of internal fistula is high.4.In the early puncture group(n = 9),compared with the late puncture group(n =37),there was 1 case show stenosis in the early puncture group(11.5%)after 1 year of internal fistula,and the patency rate was 100% after 1 year after intervention(9).In the late group,there were 5 cases of stenosis,and the stenosis rate was 13.5%.the patency rate was 97.2%(36).There were no statistically significant differences in patency rate,stenosis rate and intervention rate between the two groups.Conclusions:1.AVF FCT< 28 days compared with the FCT > 28 days,fistula stenosis rate has no significant difference within 1 years later,and patency rate of FCT< 28 group is not lower than late group.when meet the brachial artery flow >513.5ml/min,cephalic vein > 4.25 mm and physical examination in accordance with a mature judgment,emergency dialysis patients without other hemodialysispathways can early use AVF.2.he blood flow and vessel diameter of mature fistula increased significantly within 2 weeks under ultrasonic monitoring,suggesting that some mature fistulas had the conditions required for successful dialysis 2 weeks after operation.3.Early postoperative brachial artery flow and cephalic vein diameter can predict the maturity of AVF,and the prediction effect is better after one week form the operation;Postoperative brachial artery RI can predict the risk of internal fistula failure,and the prediction effect is better one day after the operation. |
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