AVALIAÇÃO MORFOLÓGICA E FUNCIONAL POR ECOGRAFIA E DOPPLER COMO FATOR PREDITIVO DA PERMEABILIDADE AOS 12 MESES EM ACESSOS VASCULARES PROXIMAIS.
Resumo
ecografia e Doppler, se associam a permeabilidade global aos 12 meses nos acessos vasculares proximais.
Material e Métodos: Estudo observacional, analítico, longitudinal, com colheita retrospetiva de dados. Foram incluídos os
doentes admitidos no nosso hospital entre Janeiro de 2011 e Junho de 2013 para a criação de acesso vascular proximal para
hemodiálise como primeiro acesso, com mapeamento vascular por ecografia e doppler. Foram comparados os doentes com
permeabilidade de acesso aos 12 meses com os doentes com falência de acesso até aos 12 meses. Foi feita análise univariada
e multivariada. Foi utilizada estatística não paramétrica com significância para α=0,05.
Resultados: Foram incluídos 61 doentes com idade média de 66,5±13,5 anos, 26 do sexo feminino, 18 fístulas umerobasílicas, 65,6% de permeabilidade global aos 12 meses. O diâmetro da artéria umeral (AU), o diâmetro da veia, o índice de resistência e a distensibilidade venosa não foram diferentes entre os grupos. O fluxo da AU (0,19l/min±0,11 vs 0,16l/min±0,06;
U=215,0; df=59; p<0,05), a velocidade picosistólica da AU (78,77m/s±23,20 vs 65,47m/s±18,47; U=210,2; df=59; p<0,05)
e a distância entre a artéria e a veia (31,73±11,9mm vs 17,75±8,61mm U=101,0; df=59; p<0,05) associaram-se a permeabilidade global aos 12 meses. A Diabetes Mellitustipo II (DMII) foi mais prevalente entre os doentes com falência aos 12 meses
(p<0,05). O diâmetro da AU correlacionou-se positivamente com o débito e a velocidade picosistólica da AU. A distensibilidade
da veia correlacionou-se negativamente com o seu diâmetro sem garrote. Na análise por regressão logística, apenas a DMII
demonstrou significância estatística, associando-se negativamente com permeabilidade aos 12 meses.
Conclusões: Nos doentes estudados, o fluxo arterial, a velocidade picosistólica e a distância entre artéria e veia são superiores entre os doentes com permeabilidade global aos 12 meses quando comparados com os doentes com falência de acesso.
A DMII mostrou ser um factor de risco independente para falência de acesso aos 12 meses.
Palavras-Chave:Ecografia, Doppler, Fístula Arteriovenosa
ABSTRACT
Background: Color Doppler Ultrasound (CDU) is essential for vascular mapping in vascular access planning/creation. The aims of this
study wereto evaluate which anatomical and hemodynamic variables from arteries and veins, measured by CDU, were associated with one
year patency in brachiocephalic and brachiobasilicprimary AV fistula.
Materials and Methods: Retrospective analysis of patients admitted at our institution between January 2011 and June 2013 for native
proximal AVF creation after CDU vascular mapping. Univariate and Multivariate analysis was performed. 12 month patency vascular
access patients were compared with 12 month non patent vascular access patients. Non-parametric statistics were used. Significance was
considered for an α=0,05.
Results: 61 patients were studied, mean age of de 66,5±13,5; 26 female; 18 brachiobasilic access, 65,6% one year patency. Brachial
artery (BA), venous diameter, Resistance Index and venous distensibility showed no differences between groups. BA flow was higher in the
year patency group (0,19l/min±0,11 vs 0,16l/min±0,06; U=215; df=59; p<0,05) as well as the peak systolic velocity (78,77m/s±23,2
vs 65,47m/s±18,47; U=210,2;df=59;p<0,05)and distance between artery and vein 31,73±11,9mm vs 17,75±8,61mm U=101,0;
df=59; p<0,05). Prevalence of type II diabetes mellitus were higher in the non-patency group (p<0,05). BA diameter correlates with BA
flow and peak systolic velocity. Vein compliance shows a negative correlation with vein diameter. By logistic regression only type II diabetes
mellitus influenced one year patency in a negative way.
Conclusions: In this group of patients, higher brachial artery flow, higher peak systolic velocity of brachial artery and higher distance
between artery and vein were associated with one year patency. Type II Diabetes Mellitus was a risk factor for one year patency.
Keywords:Ultrasonography, Doppler, Arteriovenous Fistula
Texto Completo:
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