TITLE: Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula.

Introduction: Most guidelines in different countries recommend waiting more than 2 weeks for the initial cannulation of an arteriovenous fistula (AVF) after its creation. Although an experienced examiner can subjectively determine if an AVF is ready for early cannulation, there is a lack of objective information to guide whether early cannulation is appropriate or how early cannulation may affect an AVF's primary patency. The current study examined the relationship between the initial cannulation and the prognosis of AVF, considering ultrasonography (US) findings.

Methods: This retrospective observational study enrolled 103 patients with end-stage renal disease who had started hemodialysis therapy from 2013 to 2015 at the Juntendo University Hospital. All patients had been given a primary AVF before or after the initiation of dialysis, had undergone US examinations both before and 7 days after surgery, had initially cannulated the AVF at ≥7 days after surgery, and were observed for over 1 year.

Results: The factor associated with the loss of primary patency was a resistance index of brachial artery ≥0.65 on US examination at 7 days after surgery. There was no significant difference in patency rate between the early (within 14 days after surgery) and late initial cannulation groups (≥15 days after surgery).

Conclusion: Because a resistance index <0.65 on US findings at 7 days after surgery was a good indicator for predicting an excellent patency rate when we performed first cannulation of AVF located in the forearm within 2 weeks after its creation, 1-week postoperative US evaluation may provide crucial information.

SOURCE: Shimizu Y, Nakata J, Maiguma M, et al. Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula[J]. Kidney Int Rep, 2020, 5(10):1746-1752. DOI: 10.1016/j.ekir.2020.07.030.

简介：不同国家/地区的大多数指南都建议，动静脉内瘘（AVF）创建后，要等待2周以上才能进行初始穿刺。尽管经验丰富的检查员可以主观确定AVF是否已准备好进行早期穿刺，但缺乏客观的信息来指导早期穿刺是否合适，或者早期穿刺对动静脉内瘘的主要通畅率有多大影响。本研究结合超声(US)检查结果，研究了首次穿刺与AVF预后之间的关系。

方法：这项回顾性观察研究纳入了2013年至2015年在Juntendo大学医院开始接受血液透析治疗的103例终末期肾病患者。所有患者在开始透析之前或之后均接受了原发性AVF，在手术前和术后7天接受了US检查，最初在手术后7天进行了AVF插管，并观察了1年以上。

结果：与原发通畅性丧失相关的因素是术后7天经US检查的肱动脉阻力指数0.65。早期（术后14天之内）和晚期初始穿刺组（术后15天）之间的通畅率没有显着差异。

结论：由于当我们在建立后2周内对位于前臂的AVF进行首次穿刺的情况下，术后7天US表现的阻力指数<0.65是可以预测优异的通畅率的良好指标，因此，术后1周进行US评估可能提供关键信息。

启发：随着各种探索与新的思考，内瘘成熟标准变得不清晰，部分专家提出内瘘成熟标准应该是个体化的，如果内瘘满足患者当前透析的要求，就应该认为是成熟的，所谓的666或556或455等原则，是一个大致的概念。当内瘘发育到一定程度后，早期穿刺和晚期穿刺的通畅率是没有统计学差异的，也提示我们内瘘发育时间可以更短，或者不像我们既往认为的那样需要6-8周、2-3个月时间，术后2周都是可以进行尝试穿刺了，对现有的部分观点的确是一种挑战，有许多个体化的方案需要我们去探索并确认。