摘要
目的 探讨小内径头静脉行自体动静脉内瘘(AVF)术在血液透析应用中的可行性和安全性。方法 收集2015年1月至2021年1月莆田学院附属医院收治的42例头静脉内径﹤2.5 mm的终末期肾病患者的临床资料,所有患者均行AVF术。观察AVF术成功率和AVF成熟情况,分析AVF成熟的影响因素,采用受试者工作特征(ROC)曲线评估头静脉内径对AVF成熟的预测价值。结果 42例终末期肾病患者中,12例患者采取肱动脉-头静脉自体动静脉内瘘(BCAVF),30例患者采取桡动脉-头静脉自体动静脉内瘘(RCAVF)。42例终末期肾病患者中,造瘘成功患者37例,术后AVF成熟并且可用于血液透析的患者32例。内瘘成熟情况与小内径头静脉的ESRD患者的头静脉内径有关(P﹤0.05)。头静脉内径预测AVF成熟的AUC为0.828(95%CI:0.705~0.951),约登指数为0.594,对应的最佳截断值为2.25mm,灵敏度为100%,特异度为59.40%。结论 对于内径﹤2.5mm的头静脉,可选择行AVF术,其手术成功率和AVF成熟率均较高,临床应用效果较好,可有效应用于血管条件较差的终末期肾病患者。同时,头静脉内径在预测AVF成熟方面具有一定的应用价值。
Objective To investigate the feasibility and safety of autogenous arteriovenous fistula(AVF)operation of small inner diameter cephalic vein in hemodialysis.Method The clinical data of 42 end-stage renal disease patients with cephalic vein inner diameter<2.5 mm who underwent AVF and were admitted to the Affiliated Hospital of Putian University from January 2015 to January 2021 were collected.The success rate of AVF operation and the maturity of AVF were observed.The influencing factors of AVF maturation were analyzed.The predictive value of cephalic vein inner diameter on AVF maturation was evaluated using receiver operating characteristic(ROC)curve.Result Among the 42 patients with end-stage renal disease,12 patients underwent brachial-cephalic AVF(BCAVF),and 30 patients underwent radial-cephalic AVF(RCAVF).Among the 42 patients with end-stage renal disease,37 patients had successful fistula,and 32 patients had mature AVF and could be used for hemodialysis.The maturity of the internal fistula was related to the inner diameter of the cephalic vein in ESRD patients with small inner diameter cephalic vein(P<0.05).The AUC of cephalic vein inner diameter for predicting AVF maturity was 0.828(95%CI:0.705-0.951),Youden’s index was 0.594,the corresponding optimal cut-off value was 2.25 mm,the sensitivity was 100%,and the specificity was 59.40%.Conclusion For cephalic veins with inner diameter<2.5 mm,AVF could be selected,and its operation success rate and AVF maturity rate are high,and the clinical application effect is good,and the method can be effectively applied to patients with end-stage renal disease with poor vascular conditions.At the same time,the inner diameter of the cephalic vein has a certain application value in predicting the maturity of AVF.
作者
方碧晴
林梅芳
许永成
黄明焕
陈洪
黄建强
Fang Biqing;Lin Meifang;Xu Yongcheng;Huang Minghuan;Chen Hong;Huang Jianqiang(Department of Nephrology,Affiliated Hospital of Putian University,Putian 351100,Fujian,China;Department of General Surgery,the 900th Hospital of the Joint Logistics Support Force,Fuzhou 350025,Fujian,China)
出处
《血管与腔内血管外科杂志》
2023年第4期470-474,共5页
Journal of Vascular and Endovascular Surgery
关键词
自体动静脉内瘘
终末期肾病
头静脉
内径
内瘘成熟
autogenous arteriovenous fistula
end-stage renal disease
cephalic vein
inner diameter
fistula maturation
