Title: Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives.

Abstract:  Autogenous radial-cephalic direct wrist arteriovenous fistula (RC-AVF) in the non-dominant arm is the gold standard for dialysis vascular access. However, the RC-AVF non-maturation rate is significant (≃ 40%) due to an increasingly elderly and comorbid population incidence. A detailed identification of the biological cascade underlying arteriovenous fistula (AVF) maturation could be the key to clinical research aimed at identify the group of patients at risk of primary AVF failure. Currently, careful post-operative monitoring remains the most crucial aspect to overcome the problem of impaired maturation. Up to 80% of patients with immature RC-AVF have problems potentially solvable with early endovascular or surgical correction. Physical examination by experienced practitioners in conjunction with duplex ultrasound examination (DUS) can identify physical signs of non-maturation, understand the underlying cause, and drive for a tailored early planning to treat the complication. New approaches for the early assessment of AVF maturation are under study. Techniques to promote RC-AVF maturation performed through the administration of pre-or peri-operative drugs have missed up to now to prove an efficacy in improving fistula success. The new techniques tested after surgery appear to hold future promise for improving fistula maturation.

Source：Pirozzi N, Mancianti N, Scrivano J, et al. Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives[J]. Vasc Health Risk Manag, 2021, 17:111-121. DOI: 10.2147/VHRM.S205130.

摘要：非优势臂自体桡头直接腕部动静脉内瘘（RC-AVF）是透析血管通路的金标准。但是，由于人口老龄化和合并症的发生，RC-AVF的未熟率非常高（≃ 40％）。对动静脉瘘(AVF)成熟度下的生物级联进行详细的识别可能是临床研究的关键，目的是识别有原发性AVF失败风险的患者组。当前，仔细的术后监测仍然是克服成熟度受损问题的最关键方面。 高达80%的未成熟RC-AVF患者有可能通过早期血管内或手术矫正解决问题。由经验丰富的医生进行体检，结合双功超声检查(DUS)，可以识别未成熟的体征，了解潜在原因，并推动制定量身定制的早期计划来治疗并发症。早期评估AVF成熟度的新方法正在研究中。到目前为止，通过术前或围手术期给药来促进RC-AVF成熟的技术还没有被证明在改善瘘管成功率方面有效。手术后测试的新技术似乎为改善瘘管成熟度带来了未来的希望。

启发：内瘘成熟率偏低仍是临床关注的重要问题，通过适当的方法监测内瘘成熟情况，适时制定治疗方案，可促进内瘘的成熟。