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El estudio intraoperatorio con eco-döppler puede aumentar la permeabilidad de los accesos vasculares para hemodiálisis


Post sobre Accesos vasculares, enviado el 8/08/2012 por Dr. Gaspar Mestres Alomar

Se trata de un artículo publicado recientemente, en el que se estudian varios factores físicos y mediante ultrasonidos intraoperatorios durante la realización de fí­stulas arteriovenosas, y su valor pronóstico en la permeabilidad a un mes de las mismas.
La conclusión es que el eco-döppler (velocidades final-diastólicas superiores a 24.5cm/s) arteriales es el mejor factor predictor de permeabilidad de la fí­stula, si bien la exploración física (thrill al finalizar la intervención) ofrece resultados muy similares exigiendo un esfuerzo mucho menor.

Aquí tenéis la referencia y el resumen:

Mestres G, Fontseré N, García-Madrid C, Campelos P, Maduell F, Riambau V. Intra-operative factors predicting 1-month arteriovenous fistula thrombosis. J Vasc Access. 2012;13:193-7.

Y aquí tenéis el abstract:
PURPOSE: The aim of this study is to determine clinical and ultrasound intra-operative factors related to 1-month autogenous arteriovenous fistula (AVF) thrombosis in end-stage renal failure patients.

METHODS: A prospective study was designed, including AVF performed between October 2009 and May 2010. Patient characteristics and intra-operative measurements (clinical and ultrasound findings in both artery and vein: diameters, peak-systolic, end-diastolic and mean velocities, flow and resistance index) were recorded. At 1-month follow-up, AVF primary patency was analyzed. Stepwise logistic regression and ROC curves of the resulting test were used.

RESULTS: 111 autogenous end-to-side AVF (44 radiocephalic, 45 brachiocephalic, 22 brachiobasilic) in 101 patients were performed. One-month primary patency rate was 84.7%. Intra-operative absence of bruit following skin closure could predict 1-month AVF thrombosis (70.6% sensitivity and 80.9% specificity, better than absence of thrill: 35.3% and 87.2%). However, logistic regression identified intra-operative end-diastolic velocity in the proximal feeding artery after AVF creation (EDV) as the best independent predictor of 1-month AVF thrombosis (OR=1.072, 95%CI 1.036-1.109; 76.5% sensitivity and 84.0% specificity for EDV<24.5 cm/s). This is a slight improvement on isolated clinical findings, but nevertheless a low positive predictive value (46.4%) is attained.

CONCLUSIONS: Prediction of AVF thrombosis with intra-operative ultrasound measurements (proximal artery EDV under 24.5 cm/s) can slightly improve isolated clinical findings, helping to establish an intra-operative criterion to review AVF and increase surgical efficiency, assuming a relatively low positive predictive value.