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논문분류	춘계학술대회 초록집
제목	Resistance Index in Ultrasound Mapping Predicts Successful Maturation of Arteriovenous Fistula without Interventional Assistance
저자	Hyeon Seok Hwang1, Yaeni Kim1, Jeong Kye Hwang2, Ji Il Kim2, Suk Young Kim1, Yong-Soo Kim1
출판정보	2015; 2015(1):
키워드	자가동정맥루, 성숙, 저항계수, 중재
초록	Background: Arteriovenous fistula (AVF) is the most preferred vascular access for hemodialysis and it frequently needs interventional assistance to facilitate maturation. However, there is no reliable indicator to identify which AVF successfully matures without interventional assistance. Methods: In 174 patients, who had mature AVF, parameters of duplex ultrasound (US) were analyzed to evaluate whether preoperative vascular mapping predicts unassisted AVF maturation. Results: Successful AVF maturation without interventional assistance was observed in 142 (81.1%) patients. The area under the receiver-operating characteristic curve used to predict unassisted AVF maturation was 0.61 of resistance index (RI) (p=0.046). The best cutoff value of RI was 0.80 (sensitivity, 0.56; specificity 0.70). The patients with RI≤0.8 achieved significantly increased blood flow rate at one week after access creation than those with RI >0.8 (1201.6±791.0 ml/min vs. 844.5±509.8 ml/min; p=0.002). In multivariate logistic regression, patients with RI ≤0.8 were independently associated with the higher rate of unassisted AVF maturation (OR 3.59; 95% CI 1.35-9.55; p=0.010). Other predictors of unassisted maturation included female gender, body mass index, history of previous access and venous diameter. Of the patients with assisted maturation, 23 (13.2%) patients had access stenotic lesions in angiography and they had a significantly higher RI values in US mapping compared to those with unassisted AVF maturation. (0.79±0.27 vs. 0.67±0.27; p=0.049). Conclusion: The low RI value (≤0.8) in preoperative US vascular mapping is an independent predictor for AVF maturation without interventional assistance, and patients with high RI value should be closely monitored for the necessity of intervention, especially for the access stenotic lesions.
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