Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.001518
Jornal Vascular Brasileiro
Original Article

Influência dos achados intraoperatórios no fluxo imediato de fístulas radiocefálicas de punho para hemodiálise

Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

Afonso César Polimanti, Rafael Vilhena de Carvalho Fürst, Sidnei José Galego, Alexandre Sacchetti Bezerra, Fernando Adami, João Antônio Corrêa

Downloads: 0
Views: 157

Resumo

Contexto: O fluxo adequado de uma fístula arteriovenosa recém-confeccionada depende de múltiplas características dos vasos, bem como de comorbidades do paciente. Diversos estudos associam achados pré-operatórios e suas relações à falha do acesso, mas poucos analisam a influência dos achados encontrados no intraoperatório. Objetivos: Avaliar o valor preditivo desses achados no fluxo imediato de fístulas arteriovenosas radiocefálicas de punho (FAVRCPs) para hemodiálise através de coleta de dados facilmente mensuráveis do intraoperatório. Métodos: Um único cirurgião realizou 101 FAVRCPs em 100 pacientes, em um único centro. Analisou-se o fluxo do pós-operatório imediato através da intensidade do frêmito imediatamente após a confecção do acesso, e os resultados foram comparados com dados demográficos e achados intraoperatórios. As variáveis analisadas foram sexo, idade, comorbidades, extensão da veia visível ao exame físico, presença de calcificação arterial macroscópica, diâmetro venoso máximo e extensão de veia livre de estenose, avaliadas através da cateterização venosa com sonda uretral durante o procedimento. O teste de qui-quadrado foi utilizado tanto para excluir um possível viés de confusão pelo lado do acesso como para avaliar o valor preditivo das variáveis na intensidade do frêmito. Resultados: Não foi identificada diferença significativa nas variáveis segundo o lado do acesso. A ausência de calcificação arterial, a possibilidade de cateterização venosa com sonda de 6 French ou maior, e a sua progressão por mais de 10 cm através do lúmen da veia proximal tiveram correlação com frêmito imediato adequado ao fim do procedimento (p = 0,004, p < 0,001 e p = 0,005, respectivamente). Conclusões: Nesta série de 101 FAVRCPs, o diâmetro e a progressão de cateter 6 French ou maior através da veia proximal e a ausência de calcificação arterial apresentaram valor preditivo positivo na obtenção de frêmito imediato adequado de FAVRCP para hemodiálise.

Palavras-chave

diálise renal; fatores de risco; derivação arteriovenosa; cirúrgica/efeitos adversos/métodos; valor preditivo dos testes; trombose/diagnóstico/etiologia/fisiopatologia.

Abstract

Background: Adequate flow through a newly created arteriovenous fistula depends on multiple characteristics of the vessels and patient comorbidities. Several studies have related preoperative findings to failure, but few have analyzed the influence of intraoperative findings. Objectives: To evaluate the predictive value of intraoperative findings on the immediate outcome of radial-cephalic arteriovenous wrist fistulas (RCAVF) by collecting data that are easily measured intraoperatively. Methods: We designed a cross-sectional study, in which a single surgeon performed 101 RCAVF in 100 patients at a single center. We analyzed the immediate postoperative flow, assessed by thrill intensity immediately after fistula creation, against patient demographics and intraoperative data. The following variables were analyzed: age, sex, comorbidities, length of vein visible at preoperative examination, macroscopic arterial calcification, maximum vein diameter, and length of stenosis-free vein, measured by cannulation with a urethral catheter during the procedure. The chi-square test was used both to eliminate possible bias introduced by side of venous access (left or right), and to determine predictive values of immediate thrill. Results: Side of access was not associated with any significant differences in variables. Absence of macroscopic arterial calcification, successful venous catheterization using a 6 French catheter or larger, and ability to advance it more than 10 centimeters along the lumen of the proximal vein were correlated with adequate immediate postoperative thrill (p = 0.004, p < 0.001, and p = 0.005, respectively). Conclusions: In this series of 101 RCAVF, both the diameter of the catheter and its progress through the proximal vein and also absence of arterial calcification had positive predictive value for achieving adequate immediate thrill after vascular access construction.

Keywords

renal dialysis; risk factors; arteriovenous shunt; surgical/adverse effects/methods; predictive value of tests; thrombosis/diagnosis/etiology/physiopathology.

References

1. Quinton W, Dillard D, Scribner BH. Cannulation of blood vessels for prolonged hemodialysis. Trans Am Soc Artif Intern Organs. 1960;6:104-13. PMid:13738750.

2. Foran RF, Golding AL, Treiman RL, De Palma JR. Quinton-scribner cannulas for hemodialysis. Review of four years’ experience. Calif Med. 1970;112(3):8-13. PMid:5451620.

3. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966;275(20):1089-92. http://dx.doi.org/10.1056/NEJM196611172752002. PMid:5923023.

4. National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis. 2006;48(Suppl. 1):S1-322.

5. Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg. 1996;12(2):207-13. PMID: 8760984.

6. Hodges TC, Fillinger MF, Zwolak RM, Walsh DB, Bech F, Cronenwett JL. Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg. 1997;26(6):1009-19. http://dx.doi.org/10.1016/S0741-5214(97)70014-4. PMid:9423717.

7. Lauvao LS, Ihnat DM, Goshima KR, Chavez L, Gruessner AC, Mills JL Sr. Vein diameter is the major predictor of fistula maturation. J Vasc Surg. 2009;49(6):1499-504. http://dx.doi.org/10.1016/j.jvs.2009.02.018. PMid:19497513.

8. Cruz RN, Retzlaff G, Gomes RZ, Reche PM. Influência do diabetes mellitus sobre a perviedade da fístula arteriovenosa para hemodiálise. J Vasc Bras. 2015;14(3):217-23. http://dx.doi.org/10.1590/1677-5449.0008.

9. Tordoir JHM, Rooyens P, Dammers R, van der Sande FM, de Haan M, Yo TI. Prospective evaluation of failure modes in autogenous radiocephalic wrist access for haemodialysis. Nephrol Dial Transplant. 2003;18(2):378-83. http://dx.doi.org/10.1093/ndt/18.2.378. PMid:12543895.

10. Neves MA Jr, Petnys A, Melo RC, Rabboni E. Acesso vascular para hemodialise: o que ha de novo? J Vasc Bras. 2013;12(3):221-5. http://dx.doi.org/10.1590/jvb.2013.044.

11. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557-60. http://dx.doi.org/10.1111/j.1525-139X.2008.00477.x. PMid:18764788.

12. Glass C, Johansson M, DiGragio W, Illig KA. A meta-analysis of preoperative duplex ultrasound vessel diameters for successful radiocephalic fistula placement. Journal for Vascular Ultrasound. 2009;33(2):65-8. http://dx.doi.org/10.1177/154431670903300201.

13. Jemcov TK. Morphologic and functional vessels characteristics assessed by ultrasonography for prediction of radiocephalic fistula maturation. J Vasc Access. 2013;14(4):356-63. http://dx.doi.org/10.5301/jva.5000163. PMid:23817950.

14. Bashar K, Clarke-Moloney M, Burke PE, Kavanagh EG, Walsh SR. The role of venous diameter in predicting arteriovenous fistula maturation: when not to expect an AVF to mature according to pre-operative vein diameter measurements? A best evidence topic. Int J Surg. 2015;15:95-9. PMID: 25659365. http://dx.doi.org/10.1016/j.ijsu.2015.01.035.

15. Saucy F, Haesler E, Haller C, Déglise S, Teta D, Corpataux JM. Is intraoperative blood flow predictive for early failure of radiocephalic arteriovenous fistula? Nephrol Dial Transplant. 2010;25(3):862-7. http://dx.doi.org/10.1093/ndt/gfp577. PMid:19892754.

16. Marie Y, Guy A, Tullett K, Krishnan H, Jones RG, Inston NG. Patterns of blood flow as a predictor of maturation of arteriovenous fistula for haemodialysis. J Vasc Access. 2014;15(3):169-74. http://dx.doi.org/10.5301/jva.5000214. PMid:24811589.

17. Jamil M, Usman R. Predictive parameters for successful functional maturation of native arteriovenous fistula. J Ayub Med Coll Abbottabad. 2015;27(4):821-4. PMid:27004331.

18. Srivastava A, Mittal V, Lal H, et al. Spiral laminar flow, the earliest predictor for maturation of arteriovenous fistula for hemodialysis access. Indian J Urol. 2015;31(3):240-4. http://dx.doi.org/10.4103/0970-1591.159650. PMid:26166969.

19. Galego SJ, Corrêa JA, Yamazaki YR, et al. Estudo retrospectivo da influência dos parâmettros intra-operatórios no valor preditivo do fluxo imediato de fístulas arteriovenosas realizadas para acesso de hemodiálise. Rev Méd IAMSPE. 2006;31(1):15-8.

20. Galego SJ, Goldenberg S, Ortiz JP, Deoliveira Gomes P, Ramacciotti E. Comparative blood flow study of arteriovenous fistulae in canine femoral arteries: modified latero-lateral and end-lateral techniques. Artif Organs. 2000;24(3):235-40. http://dx.doi.org/10.1046/j.1525-1594.2000.06526.x. PMid:10759648.

21. Centofanti G, Fujii EY, Cavalcante RN, et al. An experience of vascular access for hemodialysis in Brazil. Int Arch Med. 2011;4(1):16. http://dx.doi.org/10.1186/1755-7682-4-16. PMid:21569616.

22. Sahasrabudhe P, Dighe T, Panse N, Deshpande S, Jadhav A, Londhe S. Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature. Indian J Plast Surg. 2014;47(3):362-9. PMid:25593421.

23. Huber TS, Ozaki CK, Flynn TC, et al. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg. 2002;36(3):452-9. http://dx.doi.org/10.1067/mva.2002.127342. PMid:12218966.

24. Sahasrabudhe P, Dighe T, Panse N, Patil S. Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis. Indian J Nephrol. 2013;23(3):191-5. http://dx.doi.org/10.4103/0971-4065.111845. PMid:23814417.

25. Prischl FC, Kirchgatterer A, Brandstätter E, et al. Parameters of prognostic relevance to the patency of vascular access in hemodialysis patients. J Am Soc Nephrol. 1995;6(6):1613-8. PMid:8749688.

26. Olsha O, Hijazi J, Goldin I, Shemesh D. Vascular access in hemodialysis patients older than 80 years. J Vasc Surg. 2015;61(1):177-83. http://dx.doi.org/10.1016/j.jvs.2014.07.005. PMid:25107601.

27. Patel ST, Hughes J, Mills JL Sr. Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access. J Vasc Surg. 2003;38(3):439-45, discussion 45. http://dx.doi.org/10.1016/S0741-5214(03)00732-8. PMid:12947249.

28. Won T, Jang JW, Lee S, Han JJ, Park YS, Ahn JH. Effects of intraoperative blood flow on the early patency of radiocephalic fistulas. Ann Vasc Surg. 2000;14(5):468-72. http://dx.doi.org/10.1007/s100169910082. PMid:10990556.

29. Gonzalez AJ, Casey KM, Drinkwine BJ, Weiss JS. Series of noncontrast time-of-flight magnetic resonance angiographies to identify problems with arteriovenous fistula maturation. Ann Vasc Surg. 2016;30:93-9. http://dx.doi.org/10.1016/j.avsg.2015.07.005. PMid:26256701.

30. Polkinghorne KR, Atkins RC, Kerr PG. Determinants of native arteriovenous fistula blood flow. Nephrology (Carlton). 2004;9(4):205-11. http://dx.doi.org/10.1111/j.1440-1797.2004.00257.x. PMid:15363051.

31. Bessa KL, Ortiz JP. Flow visualization in arteriovenous fistula and aneurysm using computational fluid dynamics. J Vis (Tokyo). 2009;12(2):95-107. http://dx.doi.org/10.1007/BF03181952.

32. Trerotola SO, Ponce P, Stavropoulos SW, et al. Physical Examination versus Normalized Pressure Ratio for Predicting Outcomes of Hemodialysis Access Interventions. J Vasc Interv Radiol. 2003;14(11):1387-93. http://dx.doi.org/10.1097/01. RVI.0000096760.74047.34. PMid:14605103.

33. Corrêa JA, Pires AC, Kafejian O, et al. Superficial saphenofemoral arteriovenous fistula as access to hemodialysis - Description of operative technique and initial clinical experience. J Vasc Bras. 2005;4(4):341-8.

34. Karwowski W, Naumnik B, Szczepanski M, Mysliwiec M. The mechanism of vascular calcification - a systematic review. Med Sci Monit. 2012;18(1):RA1-11. http://dx.doi.org/10.12659/MSM.882181. PMid:22207127.

35. Kim YO, Choi YJ, Kim JI, et al. The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. J Korean Med Sci. 2006;21(2):284-9. http://dx.doi.org/10.3346/jkms.2006.21.2.284. PMid:16614515.

36. Kim YO, Song HC, Yoon SA, et al. Preexisting intimal hyperplasia of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients. Am J Kidney Dis. 2003;41(2):422-8. http://dx.doi.org/10.1053/ajkd.2003.50051. PMid:12552505.

37. Kheda MF, Brenner LE, Patel MJ, et al. Influence of arterial elasticity and vessel dilatation on arteriovenous fistula maturation: a prospective cohort study. Nephrol Dial Transplant. 2010;25(2):525-31. http://dx.doi.org/10.1093/ndt/gfp462. PMid:19755475.

38. Nursal TZ, Oguzkurt L, Tercan F, et al. Is routine preoperative ultrasonographic mapping for arteriovenous fistula creation necessary in patients with favorable physical examination findings? Results of a randomized controlled trial. World J Surg. 2006;30(6):1100-7. http://dx.doi.org/10.1007/s00268-005-0586-8. PMid:16736343.

39. Robbin ML, Chamberlain NE, Lockhart ME, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225(1):59-64. http://dx.doi.org/10.1148/radiol.2251011367. PMid:12354984.

40. Fila B, Lovcic V, Sonicki Z, Magas S, Sudar-Magas Z, Malovrh M. Vein diameter after intraoperative dilatation with vessel probes as a predictor of success of hemodialysis arteriovenous fistulas. Med Sci Monit. 2014;20:191-8. http://dx.doi.org/10.12659/MSM.890155. PMid:24496387.

5cd196360e8825e83e632f90 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections