Glass Carolyn, Porter John, Singh Michael, Gillespie David, Young Kate, Illig Karl
University of Rochester Medical Center, Rochester, NY 14642, USA.
Ann Vasc Surg. 2010 Jan;24(1):85-91. doi: 10.1016/j.avsg.2009.05.006. Epub 2009 Jul 23.
The incidence of stage 5 chronic kidney disease requiring immediate hemodialysis treatment continues to rise with an increasing number of patients with an unsuitable cephalic vein or failed radio- and brachiocephalic fistulae. In these patients the basilic vein is our next autologous choice. We have previously investigated our preliminary experience and identified common failure modes, and this report describes longer-term outcomes and what we feel are results after the learning curve has been surmounted.
All patients who underwent basilic vein transposition from April 2001 to June 2008 at our institution were retrospectively reviewed. Data collected included demographics, anesthesia type, volume flow at creation, maturation rate, patency rates, post-operative complications, secondary interventions (endovascular and open surgical revision), and overall mortality.
Two hundred seventeen upper arm basilic vein transposition fistulae were created in 215 patients (53% male). Prior to basilic transposition, patients had a mean of 2.9 previous surgical access attempts. Only 14% of patients had a basilic vein transposition as their initial fistula. Mean flow at time of fistula creation was 347 (range 10-880) mL/minute, with a maturation rate of 87%. The procedural mortality rate was 0.5%. Primary and primary assisted patency rates at 6, 12, and 24 months were 63%, 40%, and 26% and 74%, 56%, and 38%, respectively, while secondary patency rates at 6, 12, and 24 months were 85%, 72%, and 65%, respectively. Fistula thrombosis was the most common complication prior to maturation (16%). Central vein stenosis (22%) was the most frequent cause of fistula failure.
Basilic vein transposition fistulae have excellent initial maturation rates (87%) with reasonably good functional (secondary) patency rates (72% at 1 year). Central venous stenosis is a major postmaturation limiting factor in long-term durability, and revisions are frequent. The optimal order of access in patients without usable cephalic veins remains a difficult challenge, but basilic vein transposition seems to stack up well versus prosthetic grafts in this situation.
随着需要立即进行血液透析治疗的5期慢性肾病发病率持续上升，越来越多患者的头静脉不适用或桡动脉-头臂动静脉内瘘失败。对于这些患者，贵要静脉是我们的下一个自体血管选择。我们之前研究了初步经验并确定了常见的失败模式，本报告描述了长期结果以及我们认为在克服学习曲线后的结果。
对2001年4月至2008年6月在我院接受贵要静脉转位术的所有患者进行回顾性研究。收集的数据包括人口统计学资料、麻醉类型、造瘘时的血流量、成熟率、通畅率、术后并发症、二次干预（血管内和开放手术修复）以及总死亡率。
215例患者（53%为男性）共创建了217例上臂贵要静脉转位内瘘。在进行贵要静脉转位之前，患者平均有过2.9次先前的手术造瘘尝试。只有14%的患者将贵要静脉转位作为其初始内瘘。造瘘时的平均血流量为347（范围10 - 880）毫升/分钟，成熟率为87%。手术死亡率为0.5%。6个月、12个月和24个月时的初次和初次辅助通畅率分别为63%、40%和26%以及74%、56%和38%，而6个月、12个月和24个月时的二次通畅率分别为85%、72%和65%。内瘘血栓形成是成熟前最常见的并发症（16%）。中心静脉狭窄（22%）是内瘘失败最常见的原因。
贵要静脉转位内瘘具有出色的初始成熟率（87%），功能（二次）通畅率也相当不错（1年时为72%）。中心静脉狭窄是成熟后长期耐用性的主要限制因素，且修复频繁。对于没有可用头静脉的患者，最佳的造瘘顺序仍然是一个难题，但在这种情况下，贵要静脉转位与人工血管相比似乎效果良好。
