Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492008000300005
Jornal Vascular Brasileiro
Original Article

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

Evaluation of hemodialysis arteriovenous fistula maturation by color-flow Doppler ultrasound

Jeferson Freitas Toregeani; Claudio Jundi Kimura; Antonio S. Trigo Rocha; Giuliano Giova Volpiani; Ângela Bortoncello; Keity Shirasu; Luiz A. Peres

http://dx.doi.org/10.1590/S1677-54492008000300005 J Vasc Bras, vol.7, n3, p.203-213, 2008
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Resumo

CONTEXTO: Quando se confecciona uma fístula arteriovenosa para hemodiálise (FAVH) autógena, é necessário que se aguarde a dilatação da veia em questão e o desenvolvimento de volume de fluxo mínimo, fenômeno chamado de maturação. Ainda hoje se discute qual o tempo necessário para ocorrer essa maturação. OBJETIVO: Avaliar a maturação de FAVH utilizando-se critérios ecográficos. MÉTODO: Entre maio de 2004 e 2005, 40 pacientes foram selecionados prospectivamente, sendo 23 homens (57,5%), com média de idade de 17,5±51,3 anos, com indicação de confecção de uma FAVH. Utilizou-se o aparelho Logic III® com transdutor de 10 MHz para a avaliação no pré-operatório e nos 7º, 14º, 21º e 28º dias de pós-operatório. Os critérios para a maturação após a cirurgia foram: veia com diâmetro médio maior que 4 mm e volume de fluxo maior que 400 mL/min. RESULTADOS: O diâmetro médio pré-operatório foi de 3,24±1,43 e 3,71±1,37 mm para fístulas de punho e de cotovelo, respectivamente. O diâmetro final foi de 5,01±0,87 mm para as FAVH de punho (p = 0,006) e de 6,15±1,16 mm para as FAVH de cotovelo (p = 0,95). O volume de fluxo no 7º dia pós-operatório foi de 493,63±257,49 mL/min e 976,33±332,90 mL/min para as FAVH de punho e cotovelo, respectivamente. Ao final do estudo, foi calculado o valor de 556,81±288,42 mL/min nas FAVH de punho (p < 0,05) e de 1031,62±614,812 mL/min nas FAVH de cotovelo. Baseados nos dois critérios, a maturação ocorreu em 57,1% das fístulas de punho e em 100% das fístulas de cotovelo após a 1ª semana. Após 4 semanas, 67,9% das fístulas de punho e 100% das fístulas de cotovelo apresentaram maturação. CONCLUSÃO: A maioria das FAVH de cotovelo apresentou diâmetro e fluxo adequados para punção logo após a 1ª semana de pós-operatório. Para as FAVH de punho, houve melhora progressiva dos padrões de maturação com o passar das semanas, sugerindo que essas FAVH devem ser puncionadas preferencialmente após a 4ª semana de pós-operatório.

Palavras-chave

Fístula, arteriovenosa, hemodiálise, eco-Doppler colorido

Abstract

BACKGROUND: When a hemodialysis arteriovenous fistula (HAVF) is created, it is important to wait for venous dilatation and volume flow increase through the HAVF, a phenomenon called maturation. There is still some controversy as to the exact time required for this maturation to occur. OBJECTIVE: To evaluate the time required for HAVF maturation using ultrasound criteria. METHOD: From May 2004 through May 2005, 40 patients were prospectively selected. The sample was comprised of 23 men (57.5 %), mean age of 51.3±17.5 years, with indication of HAVF creation. Logic III® ultrasound with 10 MHz transducer probe was used for pre- and postoperative evaluation 7, 14, 21 and 28 days after the procedure. Criteria for maturation after the procedure were vein diameter larger than 4 mm and volume flow larger than 400 mL/min. RESULTS: Preoperative mean diameter was 3.24±1.43 and 3.71±1.37 mm for fist and elbow fistula, respectively. Final diameter of the fist HAVF was 5.01±0.87 mm (p = 0.006) and 6.15±1.16 mm for the elbow HAVF (p = 0.95). Flow volume in the 7th postoperative day was 493.63±257.49 and 976.33±332.90 mL/min, respectively, for the fist and elbow HAVF. At the end of the study, the value of 556.81±288.42 mL/min was calculated for the fist HAVF (p < 0.05) and 1,031.62±614.812 mL/min for the elbow HAVF. Based on both cut-off values, maturation occurred in 57.1% of the fist fistula and in 100% of the elbow fistula after the first week. After 4 weeks, 67.9% of the fist HAVF and 100% of the elbow HAVF presented maturation. CONCLUSION: Most elbow HAVF showed adequate diameter and flow volume for puncture 1 week after the procedure. For the fist fistula, gradual maturation occurred throughout the weeks, suggesting that these HAVF should be punctured 4 weeks after the surgery.

Keywords

Fistula, arteriovenous, hemodialysis, color-flow Doppler ultrasound

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