Diagnostic value of ultrasonic monitoring of brachial artery vascular parameters for autologous arteriovenous fistula complications
Zhang Han1, Liu Jiao1, Wang Hengjin2, Zhang Ming3, Wu Min1, Kong Wentao1
1Department of Ultrasonography, 2Department of Nephrology, 3Department of Vascular Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210009, China
Abstract：ObjectiveTo explore the diagnostic value of brachial artery vascular ultrasound inspection for autologous arteriovenous fistula (AVF) complications. MethodsRetrospective analysis of ultrasound imaging data was applied to 106 patients with chronic kidney disease undergoing AVF in the Ultrasonic Department of Drum Tower Hospital Affiliated to Medical School of Nanjing University from March 2016 to June 2020. Patients were divided into noncomplication group (n=57) and common complication group (n=49) according to ultrasound examination results. The latter was further divided into cephalic venous thrombosis group (n=8), cephalic venous stenosis group (n=31) and cephalic venous aneurysm-like dilatation group (n=21), according to the type of complications, 10 patients had two or more complications. The diameter, peak systolic velocity (PSV), enddiastolic velocity (EDV), resistance index (RI), time-averaged mean velocity (TAMV), pulsatility index (PI), and blood flow of brachial artery were measured by ultrasound. The parameters of brachial artery were compared between groups, and the diagnostic value for cephalic vein stenosis was analyzed by receiver operating characteristic（ROC）curve. ResultsThe PSV［(149.42±41.95)cm/s］,EDV［(71.75±23.62)cm/s］, TAMV［(59.25±19.79)cm/s］, blood flow ［（898.26±357.09）ml/min］ of brachial artery in non-complication group were higher than those of common complication group［(128.91±40.42)cm/s, (56.19±29.98)cm/s, (46.82±23.69)cm/s, 659.00（291.50，934.50）ml/min］,with significant differences (t=2.55，2.98，2.94, Z=-2.60, all P＜0.05）. PI［1.38（1.13，1.61）］ in noncomplication group was lower than that of the common complication group ［1.52（1.11，2.40）］, with significant difference (Z=2.13, P＜0.05). The areas under the ROC curve of brachial artery diameter, PSV, EDV, RI, PI, TAMV and blood flow for the diagnosis of cephalic venous stenosis were 0.71, 0.73, 0.76, 0.70, 0.68, 0.75, 0.81. Specificities were 68.42%, 75.44%, 91.23%, 89.47%, 92.98%, 92.98%, 91.23%, while sensibilities were 67.74%, 64.52%, 54.84%, 48.39%, 51.61%, 54.84%, 61.29% (all P＜0.01). ConclusionUltrasound monitoring of brachial artery vascular parameters has certain diagnostic value for AVF complications, and the brachial artery flow has the greatest diagnostic value for cephalic venous stenosis.
