TAO YANG1, YAN-HONG LAI2, RUI CUI2, YU-ZHU WANG2, WEN-HU LIU1
1Department of nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China - 2Department of nephro- logy, Beijing Haidian Hospital (Beijing Haidian Section of Peking University Third Hospital), Beijing 100080, China
Objective: To investigate the relationship between time of hemodialysis access-induced distal ischemia (HAIDI) of autogenous arteriovenous fistula (AVF) in wrist after surgery, and vascular remodeling (VR) of arteriovenous fistula.
Methods: A total of 55 out of 62 end-stage kidney disease patients were enrolled. History of smoking, diabetes history and artery calcification evaluated by X ray in forearm was recorded. Inner diameters of radial artery and cephlic vein were evaluated by ultrasound, and oxyhemoglobin saturation (SpO2) in extremities, as well as skin temperature in bilateral hand were re-checked. At 1 and 3 months after surgery, ischemia, SpO2, and skin temperature were re-evaluated; radial artery and fistula vein were checked by ultrasound. Patients with or without HAIDI were divided into HAIDI and non-HAIDI group.
Results: The occurrence of HAIDI was 16.1 % between HAIDI1 and HAIDI2a. The ischemia scores of 8 HAIDI patients who were identified HAIDI1 and HAIDI2a at 1 month after surgery showed no significant difference at 1 and 3 months after operation (p = 0.713). The onset time of ischemia was 1~90 days (median = 1 day). Skin temperature in HAIDI group was significantly lower than that in non-HAIDI group 1 month and 3 months after surgery (p < 0.05). the radial artery and cephlic vein gradually became larger. When compared with patients with or without steal phenomenon after operation, and at 3 months after operation, there was no significant difference in incidence of HAIDI (p = 0.348, 0.484), and in incidence of HAIDI in patients with or without fistula venous intimal hyperplasia (p = 0.568).
Conclusion: After AVF, HAIDI can be seen immediately in some patients while it emerges gradually in others in the maturing stage of fistula. Changes in the diameter of radial artery and cephalic vein are not associated with HAIDI. The distal temperature is more obvious among the clinical manifestation in mild patients.
Hemodialysis, Arteriovenous fistula, Ischemia