혈액투석을 위한 동정맥루 내 정압 및 전압 측정을 통한 기능 부전의 조기 진단

Abstract

Purpose: To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli`s theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings. Methods: From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. Δp (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings. Results: Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and Δp than those without As patients (p<0.005). Among 34 patients without As, Δp was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001). Conclusion: pT/MAP ratio was correlated with As, and Δp reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs.