TITLE: Skin perfusion pressure for predicting access-related hand ischemia following arteriovenous fistula surgery based on the brachial artery.

BACKGROUND: Access-related hand ischemia (ARHI) is a major complication of arteriovenous fistula (AVF). This study aimed to assess the predictive efficacy of skin perfusion pressure (SPP) measurement for ARHI by examining the relationship between SPP and ARHI development and progression after AVF surgery.

METHODS: Twenty-five patients (16 men and 9 women) who underwent AVF surgery based on the brachial artery between January 2018 and December 2018 were included. The pre- and postoperative SPP values were measured on the day of surgery. ARHI occurrence and severity were measured within 3 days and at 6 months after surgery. Receiver operating characteristic curve analysis was used to evaluate the prediction model of ARHI, and the cutoff points for the calculated coefficients were determined.

RESULTS: There was a significant correlation between the occurrence of immediate ARHI and the SPP gradient (p = 0.024). An SPP gradient value >50 mmHg had sensitivity and specificity values of 53.85% and 91.67%, respectively, in predicting the occurrence of immediate ARHI. A postoperative SPP <48 mmHg was significantly correlated with the occurrence of 6-month ARHI (p = 0.005), with sensitivity and specificity values of 71.43% and 83.33%, respectively.

CONCLUSION: The SPP gradient and postoperative SPP values may be effective clinical predictors of ARHI occurring immediately and 6 months after surgery, respectively, with high specificity. These findings could allow clinicians to diagnose and begin early interventions to help prevent ischemic tissue damage in hemodialysis patients following AVF surgery.

SOURCE: Bae M, Chung SW, Lee CW, et al. Skin perfusion pressure for predicting access-related hand ischemia following arteriovenous fistula surgery based on the brachial artery[J]. J Vasc Access, 2021 :1129729821993985. DOI: 10.1177/1129729821993985.

背景：通路相关的手部缺血（ARHI）是动静脉内瘘（AVF）的主要并发症之一。这项研究旨在通过检查AVF手术后皮肤灌注压（SPP）与ARHI发生与进展之间的关系，来评估皮肤灌注压（SPP）测量对ARHI的预测疗效。

方法：纳入2018年1月至2018年12月期间接受基于肱动脉的AVF手术的25例患者（16例男性和9例女性）。在手术当天测量术前和术后的SPP值。在手术后3天内和6个月内测量ARHI的发生和严重程度。通过接收工作特性曲线分析来评估ARHI的预测模型，并确定计算系数的临界点。

结果：立即发生的ARHI与SPP梯度之间存在显着相关性（p = 0.024）。在预测立即发生ARHI时，SPP梯度值> 50 mmHg的敏感性和特异性值分别为53.85％和91.67％。术后SPP <48 mmHg与6个月ARHI的发生显着相关（p = 0.005），敏感性和特异性分别为71.43％和83.33％。

结论：SPP梯度和术后SPP值可能是在手术后立即和术后6个月出现ARHI的有效临床预测指标，具有高度特异性。这些发现可以使临床医生诊断并开始早期干预，以帮助预防AVF手术后血液透析患者的缺血性组织损伤。

启发：通路相关手部缺血严重影响患者的透析舒适度，严重者影响患者手部功能，应予以重视。皮肤灌注压对手部缺血监测提供了一定的预测及观察方法。