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Randomised clinical study of the impact of routine preoperative Doppler ultrasound for the outcome of autologous arteriovenous fistulas for haemodialysis.

术前常规多普勒超声对自体动静脉内瘘血液透析结局影响的随机临床研究。

  • 影响因子:1.12
  • DOI:10.1177/1129729820927273
  • 作者列表:"Lopes JRA","Marques ALB","Correa JA
  • 发表时间:2021-01-01
Abstract

BACKGROUND:Arteriovenous fistulas are the gold standard of vascular accesses in haemodialysis; however, they have a considerable primary failure rate. This study evaluated the comparative reliability of routine preoperative Doppler ultrasound with an isolated physical examination of autologous arteriovenous fistulas within the Single Health System of Brazil and analysed the potential clinical benefit, improvement in primary failure rates and its economic impact. METHODS:A non-blind randomised clinical study group of patients undergoing a vessel mapping with preoperative Doppler ultrasound (ultrasound group) and a control group who had undergone only a physical examination (clinical group) before the vascular procedures was performed. The role of the arteriovenous fistula in dialysis and possible alterations was evaluated in both the groups and followed up for 6 months. RESULTS:Of the initial 248 eligible patients, there was a randomisation of 230 patients, 228 of whom were submitted for surgery, 114 in each group. In the clinical group, a significantly higher rate of primary failure was recorded, with 13.6% versus 4.4% in the ultrasound group (p = 0.002). The Kaplan-Meier curve with log-rank analysis showed a significantly higher primary patency in the ultrasound group (p = 0.042). Regarding the cost-effectiveness of the use of Doppler ultrasound, there was no increase in the final cost compared to the physical examination (US$1.28/fistula day × US$1.29/fistula day). CONCLUSION:It was concluded that Doppler ultrasound contributed to the reduction of primary failure, leading to a significantly superior primary patency of arteriovenous fistulas, and no increase in the final cost. This justifies its routine preoperative use in the Single Health System. Registration number RBR-474xhn (http://www.ensaiosclinicos.gov.br).

摘要

背景: 动静脉瘘是血液透析中血管通路的金标准; 然而,它们有相当大的原发性失败率。本研究评估了常规术前多普勒超声与巴西单一卫生系统内自体动静脉瘘孤立体检的比较可靠性,并分析了潜在的临床益处、原发性失败率的改善及其经济影响。 方法: 一个非盲随机临床研究组,患者接受术前多普勒超声血管标测 (超声组),对照组仅接受血管手术前的体格检查 (临床组)。在两组中评估动静脉内瘘在透析中的作用和可能的改变,并随访6个月。 结果: 在最初的248名符合条件的患者中,有230名患者随机分组,其中228人接受手术,每组114人。在临床组中,记录到的原发性失败率显著较高,超声组为13.6% 对4.4% (p = 0.002)。Kaplan-Meier曲线和log-rank分析显示超声组的初级通畅性显著更高 (p = 0.042)。关于使用多普勒超声的成本效益,与体检相比,最终费用没有增加 (1.28美元/瘘管日 × 1.29美元/瘘管日)。 结论: 多普勒超声有助于减少原发性失败,导致动静脉瘘的主要通畅性显著提高,并且不增加最终费用。这证明其在单一卫生系统中的常规术前使用是合理的。注册号RBR-474xhn (http://www.ensaiosclinicos.gov.br)。

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