Cull David L, Carsten Christopher G, Kalbaugh Corey A, York John W, Campbell Ted R, Cass Anna L, Taylor Spence M
Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina 29605, USA.
Am Surg. 2008 Jul;74(7):620-4; discussion 624-5. doi: 10.1177/000313480807400709.
The long-term survival of patients on hemodialysis is often limited by the exhaustion of vascular access sites. A fundamental principle of vascular access surgery is that the arteriovenous (AV) access be placed as far distally in the arm as possible. This principle enhances the secondary patency of the AV grafts by preserving the proximal veins for AV graft revision and provides venous outflow for a new AV access to be placed more proximally in the extremity. The standard straight and looped AV graft configurations violate this principle by bypassing long segments of vein in the extremity that could be used for AV graft revision or new AV graft placement. We have developed a novel AV graft configuration that preserves venous outflow and enhances the longevity of each AV access site. The purpose of this review is to describe the reverse J AV graft technique and to report our outcomes with the procedure. Between February 2004 and April 2007, 26 AV grafts were placed using the reverse J configuration. Eighteen (69%) AV grafts were placed in the upper arm, 7 (27%) were placed in the forearm, and 1 (4%) was placed in the thigh. Median follow-up was 320 days. The secondary AV graft patency was 90 per cent at 6 months, 84 per cent at 12 months, and 84 per cent at 18 months. Five AV grafts were subsequently revised to a loop configuration. Overall patient survival was 85 per cent at 6 months, 68 per cent at 12 months, and 62 per cent at 18 months. Compared with the standard straight and looped AV graft configurations, the reverse J AV graft configuration preserves the length of venous outflow in the extremity for AV graft revision or new AV graft placement. Therefore, the reverse J configuration enhances the secondary patency of AV graft patency and AV access site longevity.
接受血液透析治疗的患者长期生存常常受到血管通路部位耗竭的限制。血管通路手术的一项基本原则是动静脉（AV）通路应尽可能置于手臂的远端。这一原则通过保留近端静脉用于AV移植物翻修来提高AV移植物的二期通畅率，并为在肢体更近端放置新的AV通路提供静脉流出道。标准的直线型和袢型AV移植物构型违反了这一原则，因为它们绕过了肢体中可用于AV移植物翻修或新AV移植物放置的长段静脉。我们开发了一种新型的AV移植物构型，可保留静脉流出道并提高每个AV通路部位的使用寿命。本综述的目的是描述反向J型AV移植物技术并报告我们采用该手术的结果。在2004年2月至2007年4月期间，采用反向J构型放置了26个AV移植物。18个（69%）AV移植物置于上臂，7个（27%）置于前臂，1个（4%）置于大腿。中位随访时间为320天。AV移植物的二期通畅率在6个月时为90%，12个月时为84%，18个月时为84%。随后有5个AV移植物被翻修为袢型构型。患者总体生存率在6个月时为85%，12个月时为68%，18个月时为62%。与标准的直线型和袢型AV移植物构型相比，反向J型AV移植物构型保留了肢体中用于AV移植物翻修或新AV移植物放置的静脉流出道长度。因此，反向J构型提高了AV移植物通畅率的二期通畅率以及AV通路部位的使用寿命。
