对用于血液透析的动静脉内瘘中使用的镍钛诺可中断式手术夹的前瞻性评估。
A prospective evaluation of interrupted nitinol surgical clips in arteriovenous fistula for hemodialysis.
作者信息
Lin Peter H, Bush Ruth L, Nelson Jonathan C, Lam Russell, Paladugu Ramesh, Chen Changyi, Quinn Gene, Lumsden Alan B
机构信息
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, Houston VAMC (112), Houston, TX 77030, USA.
出版信息
Am J Surg. 2003 Dec;186(6):625-30. doi: 10.1016/j.amjsurg.2003.08.007.
BACKGROUND
The use of a self-closing nitinol surgical clip (Coalescent Surgical U-Clip) is a novel technique of creating an interrupted vascular anastomosis, which also eliminates the knot tying associated with a conventional vascular anastomosis. The purpose of this study was to compare the clinical outcome of arteriovenous fistulae (AVF) for hemodialysis as constructed using interrupted U-Clip devices and conventional continuous polypropylene sutures.
METHODS
We prospectively studied the clinical course of 132 patients (149 access) undergoing either forearm autologous arteriovenous fistula (FAVF, n = 69) or upper arm autologous arteriovenous fistula (UAVF, n = 80) or creations during a 39-month period. Among the FAVF, U-Clips and polypropylene sutures were used in 37 and 32 anastomoses, respectively. Among the UAVF, U-Clips and polypropylene sutures were used in 41 and 30 anastomoses, respectively. Primary patency, complication, and maturation rates were analyzed.
RESULTS
Clipped FAVF had an improved maturation rate at 6 weeks (32 of 37, 86%) when compared with sutured FAVF (22 of 32, 69%, P <0.05). There was no difference in the maturation rate among UAVF constructed with either U-Clips or sutures (88% versus 87%, not significant). The primary patency rates at 12, 24, and 36 months were 91%, 84%, and 75% for the clipped FAVF; and 83%, 74%, and 61% for the sutured FAVF (P <0.05) There was no difference in the patency rate of UAVF constructed with either U-Clips or polypropylene sutures at either 12, 24 or 36 moths (91%, 80%, and 75% versus 83%, 77%, and 69%, respectively).
CONCLUSIONS
The U-Clips are a viable alternative to sutures for creating vascular anastomosis. It provides a improved maturation and patency rates when compared with the conventional sutured AVF in the forearm. The clinical benefit of the U-Clips may be due in part to the improved compliance created by the interrupted anastomotic technique.
背景
使用自闭合镍钛诺外科夹（Coalescent Surgical U-Clip）是一种创建间断性血管吻合的新技术，它还消除了传统血管吻合中打结的步骤。本研究的目的是比较使用间断U形夹装置和传统连续聚丙烯缝线构建的用于血液透析的动静脉内瘘（AVF）的临床结果。
方法
我们前瞻性地研究了132例患者（149处通路）在39个月期间的临床病程，这些患者接受了前臂自体动静脉内瘘（FAVF，n = 69）、上臂自体动静脉内瘘（UAVF，n = 80）或血管造瘘术。在FAVF中，分别有37例和32例吻合使用了U形夹和聚丙烯缝线。在UAVF中，分别有41例和30例吻合使用了U形夹和聚丙烯缝线。分析了一期通畅率、并发症和成熟率。
结果
与缝合的FAVF（32例中的22例，69%）相比，使用U形夹的FAVF在6周时成熟率有所提高（37例中的32例，86%，P<0.05）。使用U形夹或缝线构建的UAVF成熟率没有差异（88%对87%，无统计学意义）。使用U形夹的FAVF在12个月、24个月和36个月时的一期通畅率分别为91%、84%和75%；缝合的FAVF分别为83%、74%和61%（P<0.05）。在12个月、24个月或36个月时，使用U形夹或聚丙烯缝线构建的UAVF通畅率没有差异（分别为91%、80%和75%对83%、77%和69%）。
结论
U形夹是用于创建血管吻合的缝线的一种可行替代方案。与前臂传统缝合的AVF相比，它能提高成熟率和通畅率。U形夹的临床益处可能部分归因于间断吻合技术带来的顺应性改善。
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