Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Value of Intraoperative Flow Measurements of Brachiocephalic Arteriovenous Fistulas for Hemodialysis

  • Lee, Jonggeun (Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Lee, Seogjae (Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Chang, Jee Won (Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Kim, Su Wan (Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Song, Jung-Kook (Department of Preventive Medicine, Jeju National University School of Medicine)
  • Received : 2019.08.26
  • Accepted : 2019.12.24
  • Published : 2020.06.05
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Abstract

Background: The aim of this study was to analyze the clinical outcomes of autogenous brachiocephalic arteriovenous fistulas and to investigate the factors associated with 1-year patency after initiation of hemodialysis. Methods: We retrospectively reviewed the medical records of 41 patients who underwent surgery to create an autogenous brachiocephalic arteriovenous fistula between January 2015 and December 2017, received hemodialysis at the same hospital for longer than 1 year, and were monitored for their vascular access status. Intraoperative flow was measured using transit-time ultrasonography. Results: The 1-year primary and secondary patency rates were 61% (n=25) and 87.8% (n=36), respectively. The functional group (subjects who required no intervention to maintain patency within the first year after hemodialysis initiation) displayed a significantly higher median intraoperative flow rate (450 mL/min) than the non-functional group (subjects who required intervention at least once regardless of 1-year patency) (275 mL/min) (p=0.038). Based on a receiver operating characteristic curve analysis, all patients were additionally subdivided into a high-flow group (>240 mL/min) and a low-flow group (≤240 mL/min). The high-flow group included a significantly greater number of functional brachiocephalic arteriovenous fistulas than the low-flow group (74.2% vs. 20%, respectively; p=0.007). Conclusion: Transit-time flow, as measured with intraoperative transit-time ultrasonography, was associated with patency without the need for intervention at 1 year after initiation of hemodialysis.

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