Ayarragaray Javier Eduardo Ferrari
Center for Study and Treatment of Renal Diseases, Department of Vascular and Endovascular Surgery, Buenos Aires, Argentina.
J Vasc Surg. 2003 May;37(5):1043-6. doi: 10.1067/mva.2003.215.
The most common cause of graft failure in patients undergoing hemodialysis is outflow venous stenosis. Long-term compromise of venous central trunks must be resolved.
This study was undertaken to evaluate an unusual surgical option, bypass to decompress a long-term vascular graft to the femoral vein, improving venous outflow, alleviating symptoms of venous hypertension, and restoring vascular integrity for dialysis.
The study included 3 patients with end-stage renal disease with signs and symptoms of dysfunctioning grafts. Angiographic studies showed occlusion or stricture of the central venous tract and venous outflow compromise. All patients had multiple temporary and long-term vascular access sites for hemodialysis, which were revised several times. Venous decompression was performed with a bridge to the ipsilateral femoral vein. A 6 mm reinforced polytetrafluoroethylene graft was tunneled subcutaneously along the thoracoabdominal wall. Patients were released 48 hours after the procedure, and periodic follow-up was carried out to detect changes in graft patency and function.
There were no preoperative or intraoperative complications. Clear improvement in signs and symptoms of venous hypertension were observed. Venous pressures decreased. Average follow-up was 16.3 months. In 1 patient the new graft malfunctioned, and it was revised and repaired at 25 months. The presence of deep venous thrombosis and pulmonary embolism required peritoneal dialysis. Two other patients, with no change in graft patency, died of concomitant disease.
Decompression of the femoral vein enables preservation of vascular graft patency and improves symptoms of venous hypertension.
接受血液透析的患者移植物失败的最常见原因是流出静脉狭窄。必须解决静脉中央主干的长期损害问题。
本研究旨在评估一种不寻常的手术选择，即通过旁路将长期血管移植物减压至股静脉，改善静脉流出，减轻静脉高压症状，并恢复用于透析的血管完整性。
该研究纳入了3例患有终末期肾病且有移植物功能障碍体征和症状的患者。血管造影研究显示中央静脉道闭塞或狭窄以及静脉流出受损。所有患者都有多个用于血液透析的临时和长期血管通路部位，且这些部位已多次修改。通过与同侧股静脉搭桥进行静脉减压。将一段6毫米的增强聚四氟乙烯移植物沿胸腹壁皮下隧道化。术后48小时患者出院，并进行定期随访以检测移植物通畅性和功能的变化。
术前或术中均无并发症。观察到静脉高压的体征和症状有明显改善。静脉压力下降。平均随访时间为16.3个月。1例患者的新移植物出现故障，在25个月时进行了修复。深静脉血栓形成和肺栓塞的出现需要进行腹膜透析。另外2例患者移植物通畅性无变化，死于伴发疾病。
股静脉减压可保持血管移植物通畅并改善静脉高压症状。
