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Fistelreifung: Vorhersage durch intraoperative Flussmessung

Fistula maturation: prediction by intraoperative transit time flow measurement

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Zusammenfassung

Hintergrund

Die native arteriovenöse Fistel (AVF) ist der Gefäßzugang der Wahl für die chronische Hämodialysetherapie. Ihre rechtzeitige und erfolgreiche Anlage ist von ganz besonderer Relevanz, um Katheterdialysen zu vermeiden. Nach Literaturangaben kommt es jedoch in 20–50 % der Erstanlagen zum primären Fistelversagen.

Fragestellung

Welche Faktoren beeinflussen die Fistelreifung und gibt es Prädiktoren, anhand derer die Vorhersage einer erfolgreichen Anlage möglich ist?

Material und Methode

Wir berichten über eine prospektive Kohortenstudie unter Einschluss von 41 Patienten mit Erstanlage einer AVF an der oberen Extremität. Primärer Endpunkt war die Fistelreifung nach 6 Wochen. Verschiedene konstitutionelle, demografische, hämodynamische und technische Faktoren wurden untersucht.

Ergebnisse

Einziger prädiktiver Parameter für die Fistelmaturation nach 6 Wochen war der intraoperativ gemessene Fluss in der Shuntvene. Mittels ROC-Analyse konnte ein Cut-off-Wert für das Flussvolumen in der Shuntvene ermittelt werden (170 ml/min), bei dem sich mit größtmöglicher Sensitivität (85 %) und gleichzeitig maximaler Spezifität (80 %) ein Shuntverschluss innerhalb von 6 Wochen vorhersagen ließ.

Schlussfolgerungen

Die intraoperative transiente Flussmessung ist eine einfache, jederzeit anwendbare Methode, mit deren Hilfe in einem hohen Prozentsatz eine Aussage über eine erfolgreiche AVF-Reifung möglich ist.

Abstract

Background

The autogenous arteriovenous fistula (AVF) is the access of choice for hemodialysis therapy. Its timely and successful creation is particularly important to avoid hemodialysis catheters; however, according to the literature primary failure occurs in 20–50 % of newly created AVF.

Objective

To identify factors influencing AVF maturation and thus identify predictors of successful fistula creation.

Methods

We report on a prospective cohort study of 41 patients undergoing the first upper extremity AVF placement. Primary endpoint of the study was successful fistula maturation after 6 weeks and several constitutional, demographic, hemodynamic and technical factors were investigated.

Results

The most significant predictive parameter for fistula maturation was flow volume measured in the access vein during surgery. The receiver operating characteristic (ROC) curve analysis showed a cut-off value of 170 ml/min for the blood flow volume with the best possible sensitivity (85 %) and maximum specificity (80 %) for prediction of fistula failure within 6 weeks.

Conclusion

Intraoperative transit time flow measurement is easy to perform and can be used anytime to reliably predict successful AVF maturation.

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Literatur

  1. Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, Kosa SD, Quinn RR, Moist LM (2014) Patency rates of the arteriovenous fistula for hemodialysis: A systematic review and meta-analysis. Am J Kidney Dis 63(3):464–478

    Article  PubMed  Google Scholar 

  2. Allon M, Robbin ML (2002) Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions. Kidney Int 62:1109–1124

    Article  PubMed  Google Scholar 

  3. Berman SS, Mendoza B, Westerband A, Quick RC (2008) Predicting arteriovenous fistula maturation with intraoperative blood flow measurements. J Vasc Access 9(4):241–247

    CAS  PubMed  Google Scholar 

  4. Dember LM, Imrey PB, Beck GJ, Cheung AK, Himmelfarb J, Huber TS, Kusek JW, Roy-Chaudhury P, Vazquez MA, Alpers CE, Robbin ML, Vita JA, Greene T, Gassman JJ, Feldman HI (2014) Objectives and design of the Hemodialysis Fistula Maturation Study. Am J Kidney Dis 63(1):104–112

    Article  PubMed  Google Scholar 

  5. Elfström J, Thomsen M (1981) The prognostic value of blood-flow measurements during construction of arteriovenous fistulae. Scand J Urol Nephrol 15(3):323–326

    Article  PubMed  Google Scholar 

  6. Farber AD, Imrey PB, Huber TS, Kaufman JM, Kraiss LW, Larive B, Li L, for the HFM Study Group (2016) Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg 63:163–170

    Article  PubMed  Google Scholar 

  7. Feldman HI, Kobrin S, Wasserstein A (1996) Hemodialysis vascular access morbidity. J Am Soc Nephrol 7:523–535

    CAS  PubMed  Google Scholar 

  8. Huber TS, Carter JW, Carter RL, Seeger JM (2003) Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: A systematic review. J Vasc Surg 38:1005–1011

    Article  PubMed  Google Scholar 

  9. Hakaim AG, Nalbandian M, Scott T (1998) Superior maturation and patency of primary brachiocephalic and transposed basilic vein arteriovenous fistulae in patients with diabetes. J Vasc Surg 27(1):154–157

    Article  CAS  PubMed  Google Scholar 

  10. Joannides R, Bakkali EH, Le Roy F, Rivault O, Godin M, Moore N, Fillastre JP, Thuillez C (1997) Altered flow-dependent vasodilatation of conduit arteries in maintenance haemodialysis. Nephrol Dial Transplant 12:2623–2628

    Article  CAS  PubMed  Google Scholar 

  11. Johnson CP, Zhu YR, Matt C, Pelz C, Roza AM, Adams MB (1998) Prognostic value of intraoperative blood flow measurements in vascular access surgery. Surgery 124(4):729–737

    Article  CAS  PubMed  Google Scholar 

  12. Knoll GA, Wells PS, Young D, Perkins SL, Pilkey RM, Clinch JJ, Rodger MA (2005) Thrombophilia and the risk for hemodialysis vascular access thrombosis. J Am Soc Nephrol 16:1108–1114

    Article  PubMed  Google Scholar 

  13. Konner K (2002) The anastomosis of the arteriovenous fistula – common errors and their avoidance. Nephrol Dial Transplant 17:376–379

    Article  PubMed  Google Scholar 

  14. Kosa SD, Al-Jaishi AA, Moist L, Lok CE (2015) Preoperative vascular access evaluation for haemodialysis patients. Cochrane Database Syst Rev 30(9):CD007013. doi:10.1002/14651858.CD007013.pub2

    Google Scholar 

  15. Lin CH, Chua CH, Chiang SS, Liou JY, Hung HF, Chang CH (2008) Correlation of intraoperative blood flow measurement with autogenous arteriovenous fistula outcome. J Vasc Surg 48(1):167–172

    Article  PubMed  Google Scholar 

  16. Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D (2006) Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 17(11):3204–3212

    Article  PubMed  Google Scholar 

  17. Martínez Izquierdo A, Moñux Ducaju G, Martínez López I, Sánchez Hervas L, Serrano Hernando FJ (2010) Valor pronóstico de la flujometría intraoperatoria en las fístulas nativas para hemodiálisis. Angiologia 62(3):97–102

    Article  Google Scholar 

  18. Nassar GM, Ayus JC (2001) Infectious complications of the hemodialysis access. Kidney Int 60:1–13

    Article  CAS  PubMed  Google Scholar 

  19. National Kidney Foundation (2006) KDOQI clinical practice guidelines for vascular access, update 2006. Am J Kidney Dis 48:176–276

    Article  Google Scholar 

  20. Prischl FC, Kirchgatterer A, Bradstetter E, Wallner M, Baldinger C, Roithinger FX, Kramar R (1995) Parameters of prognostic relevance to the patency of vascular access in hemodialysis patients. J Am Soc Nephrol 6:1613–1618

    CAS  PubMed  Google Scholar 

  21. Ravani P, Brunori G, Mandolfo S, Gnacarini G, Imbasciati F, Marcelli D, Malberti F (2004) Cardiovascular morbiditiy and late referral impact on arteriovenous fistula survival: A prospective multicenter study. J Am Soc Nephrol 15:204–209

    Article  PubMed  Google Scholar 

  22. Ravani P, Palmer SC, Oliver MJ, Quinn RR, MacRae JM, Tai DJ, Pannu NI, Thomas C, Hemmelgarn BR, Craig JC, Manns B, Tonelli M, Strippoli GF, James MT (2013) Associations between hemodialysis access type and clinical outcomes: A systematic review. J Am Soc Nephrol 24(3):465–473

    Article  PubMed  PubMed Central  Google Scholar 

  23. Saucy F, Haesler E, Haller C, Déglise S, Teta D, Corpataux JM (2010) Is intra-operative blood flow predictive for early failure of radiocephalic arteriovenous fistula? Nephrol Dial Transplant 25(3):862–867

    Article  PubMed  Google Scholar 

  24. Schwab SJ, Oliver MJ, Suhocki P, McCann R (2001) Hemodialysis arteriovenous access; detection of stenosis and response to treatment by vascular access flow. Kidney Int 59:358–362

    Article  CAS  PubMed  Google Scholar 

  25. Smith GE, Gohil R, Chetter IC (2012) Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg 55(3):849–855

    Article  PubMed  Google Scholar 

  26. Won T, Jang JW, Lee S, Han JJ, Park YS, Ahn JH (2000) Effects of intraoperative blood flow on the early patency of radiocephalic fistulas. Ann Vasc Surg 14(5):468–472

    Article  CAS  PubMed  Google Scholar 

  27. Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A (1996) Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 12(2):207–213

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Viszeral- und Gefäßchirurgie, Johanniter Krankenhaus Rheinhausen, Kreuzacker 1–7, 47228, Duisburg, Deutschland

    A. Meyer, R. Schenda, S. T. König & A. S. Vetter

  2. Nephrologisches Zentrum Moers, Moers, Deutschland

    E. Flicker

  3. Interdisziplinäres Shuntzentrum Duisburg, Duisburg, Deutschland

    A. Meyer, E. Flicker, R. Schenda, S. T. König & A. S. Vetter

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  1. A. Meyer
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  2. E. Flicker
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  4. S. T. König
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  5. A. S. Vetter
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Correspondence to A. Meyer.

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Interessenkonflikt

A. Meyer erhält/erhielt Drittmittel zur Durchführung der Duisburger Dialyseshunttagung von den Firmen: bionic, Boston Scientific, B. Braun, Cryolife, Fresenius, Gore, LeMaitre, medac, Medistim, Maquet, Optimed, ucb. E. Flicker, R. Schenda, S.T. König und A.S. Vetter geben an, dass kein Interessenkonflikt besteht.

Bei dem Beitrag handelt es sich um eine prospektive Studie ohne Einfluss auf die Behandlung. Alle Patienten haben ihr schriftliches Einverständnis zur anonymisierten Auswertung der Daten gegeben.

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Meyer, A., Flicker, E., Schenda, R. et al. Fistelreifung: Vorhersage durch intraoperative Flussmessung. Gefässchirurgie 21, 466–471 (2016). https://doi.org/10.1007/s00772-016-0198-7

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  • DOI: https://doi.org/10.1007/s00772-016-0198-7

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