Jornal Vascular Brasileiro
https://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

References

Silva MB Jr., Hobson RW 2nd, Pappas PJ. A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluation. J Vasc Surg. 1998;27:302-7.

Vanholder R. Vascular access: care and monitoring of function. Nephrol Dial Transplant. 2001;16:1542-5.

Corpataux JM, Haesler E, Silacci P, Ris HB, Hayoz D. Low-pressure environment and remodelling of the forearm vein in Brescia-Cimino haemodialysis access. Nephrol Dial Transplant. 2002;17:1057-62.

Wiese P, Nonnast-Daniel B. Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant. 2004;19:1956-63.

Jennings WC. Creating arteriovenous fistulas in 132 consecutive patients: exploiting the proximal radial artery arteriovenous fistula: reliable, safe, and simple forearm and upper arm hemodialysis access. Arch Surg.. 2006;141:27-32.

Clark WI, Cohen RA, Kwak A. Salvage of nonmaturing native fistulas by using angioplasty. Radiology. 2007;242(1):286-92.

Bonucchi D, D'Amelio A, Grosoli M, Baraldi A, Capelli G. Vascular access for haemodialysis: from surgical procedure to an integrated therapeutic approach. Nephrol Dial Transplant.. 1998;13(^s7):78-81.

Rayner RL, Pisoni RL, Gillespie BW. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int.. 2003;63:323-30.

Pisoni RL, Young EW, Dykstra DM. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int.. 2002;61:305-16.

Planken RN, Keuter XH, Hoeks AP. Diameter measurements of the forearm cephalic vein prior to vascular access creation in end-stage renal disease patients: graduated pressure cuff versus tourniquet vessel dilatation. Nephrol Dial Transplant. 2006;21:802-6.

Allon M, Lockhart ME, Lilly RZ. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int.. 2001;60:2013-20.

Grogan J, Castilla M, Lozanski L, Griffin A, Loth F, Bassiouny H. Frequency of critical stenosis in primary arteriovenous fistulae before hemodialysis access: Should duplex ultrasound surveillance be the standard of care?. J Vasc Surg. 2005;41(6):1000-6.

Huber TS, Ozaki CK, Flynn TC. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg. 2002;36:452-9.

Berman SS, Gentile AT. Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance. J Vasc Surg.. 2001;34:866-71.

Saran R, Pisoni RL, Young EW. Timing of first cannulation of arteriovenous fistula: are we waiting too long?. Nephrol Dial Transplant. 2005;20:688-90.

Malovrh M. Native arteriovenous fístula: preoperative evaluation. Am J Kidney Dis. 2002;39:1218-25.

Moreira RCR. Fístulas arteriovenosas para diálise: algumas lições aprendidas ao longo de 1.200 operações. Rev Angiol Cirur Vasc. 1997;6:206-11.

Mendes RR, Farber MA, Marston WA, Dinwiddie LC, Keagy BA, Burnham SJ. Prediction of wrist arteriovenous fistula maturation with preoperative vein mapping with ultrasonography. J Vasc Surg.. 2002;36:460-3.

NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001;37(1^s1):S137-81.

Duval L. Proximal radial artery arteriovenous fistulae (PRA-AVF). Nephrol Nurs J.. 2007;34:217-8.

Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1:332-9.

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;38:439-45.

Huber TS, Ozaki CK, Flynn TC. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg.. 2002;36:452-9.

Surratt RS, Picus D, Hicks ME, Darcy MD, Kleinhoffer M, Jendrisak M. The importance of preoperative evaluation of the subclavian vein in dialysis access planning. AJR Am J Roentgenol. 1991;156:623-5.

Haimovici H, Ascer E, Hollier LH, Strandness DE Jr., Towne JB. Haimovici's vascular surgery. 1996:913-37.

Chiu JJ, Chen LJ, Lee PL. Shear stress inhibits adhesion molecule expression in vascular endothelial cells induced by coculture with smooth muscle cells. Blood.. 2003;101:2667-74.

Tordoir JH, 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;18:378-83.

Brunori G, Ravani P, Mandolfo S, Imbasciati E, Malberti F, Cancarini G. Fistula maturation: doesn't time matter at all?. Nephrol Dial Transplant.. 2005;20:684-7.

Saran R, Dykstra DM, Pisoni RL. Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transplant.. 2004;19:2334-40.

Basile C, Ruggieri G, Vernaglione L, Montanaro A, Giordano R. The natural history of autogenous radio-cephalic wrist arteriovenous stulas of haemodialysis patients: a prospective observational study. Nephrol Dial Transplant.. 2004;19:1231-6.

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;14:468-72.

Yerdel MA, Kesenci M, Yazicioglu KM, Doseyen Z, Turkcapar AG, Anadol E. Effect of haemodynamic variables on surgically created arteriovenous fistula flow. Nephrol Dial Transplant.. 1997;12:1684-8.

Robbin ML, Chamberlain NE, Lockhart ME. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225:59-64.

Lin SL, Huang CH, Chen HS, Hsu WA, Yen CJ, Yen TS. Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol.. 1998;18:96-100.

Sivanesan S, How TV, Bakran A. Characterizing flow distributions in AV fistulae for haemodialysis access. Nephrol Dial Transplant.. 1998;13:3108-10.

Beathard GA, Arnold P, Jackson J, Litchfield T. Physician Operators Forum of RMS Lifeline: Aggressive treatment of early fistula failure. Kidney Int.. 2003;64:1487-94.

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