Radiologie Vasculaire Diagnostique & Interventionnelle, Clinique St-Gatien, Tours, France.
Nephrol Dial Transplant. 2010 Feb;25(2):532-8. doi: 10.1093/ndt/gfp467. Epub 2009 Sep 11.
Forearm basilic fistulas are rarely used as vascular accesses for haemodialysis but they represent a valuable option when autogenous radial-cephalic fistulas cannot be performed. There is no information in the literature to date about the outcome of direct ulnar-basilic or transposed radial-basilic forearm autogenous fistulas after endovascular treatment of stenosis or thrombosis.
This retrospective study included 78 consecutive patients from eight dialysis units who were referred to a single interventional radiology centre for endovascular treatment of delayed maturation (n = 30), dysfunction (n = 35) or thrombosis (n = 13) of their autogenous forearm ulnar-basilic (n = 62) or radial-basilic fistulas (n = 16). The male/female ratio was 54/24, mean age was 64.7 years, 26% had diabetes, 83% were treated for hypertension and the mean body mass index was 24 kg/m(2). Immature and dysfunctional fistulas were treated by dilation and thrombosed fistulas by aspiration thrombectomy. Clinical success was defined as the perception of a continuous palpable thrill and the ability to perform dialysis. Fistula patency rates were calculated with the Kaplan-Meier method.
Overall primary patency rates were 51% and 44% at 1 and 2 years, respectively. These rates were lower for immature and thrombosed fistulas compared to dysfunctional mature fistulas. Secondary patency rates were 96% and 91% at 1 and 4 years, respectively. Immediate overall clinical success was 97%. The two failures occurred with an immature and a thrombosed fistula. Immediate complications included two transient dilation-induced ruptures treated by prolonged balloon inflation. One case of subsequent hand ischaemia was successfully treated by distal artery ligation.
Endovascular treatment plays a major role in the maturation process, maintenance and salvage of radial and ulnar-basilic fistulas. The preservation of upper arm veins for the future, with low risk of hand ischaemia or hyperflow, might encourage nephrologists and surgeons to consider forearm basilic fistulas systematically in their strategy of vascular access creation.
前臂贵要静脉瘘很少被用作血液透析的血管通路，但当自体桡动脉-头静脉瘘无法进行时，它是一种有价值的选择。目前，尚无关于血管内治疗狭窄或血栓形成后直接贵要-尺侧或移位桡-贵要前臂自体瘘的结局的文献信息。
这项回顾性研究纳入了 8 个透析中心的 78 例连续患者，他们被转诊到单一介入放射学中心，接受血管内治疗自体前臂贵要-尺侧（n = 62）或桡-贵要瘘（n = 16）的延迟成熟（n = 30）、功能障碍（n = 35）或血栓形成（n = 13）。男/女比例为 54/24，平均年龄为 64.7 岁，26%有糖尿病，83%为高血压患者，平均体重指数为 24 kg/m2。未成熟和功能障碍的瘘管采用扩张治疗，血栓形成的瘘管采用抽吸血栓切除术治疗。临床成功定义为持续可触及震颤的感知和进行透析的能力。瘘管通畅率采用 Kaplan-Meier 法计算。
总体一期通畅率分别为 51%和 44%，1 年和 2 年时。未成熟和血栓形成的瘘管的通畅率低于功能成熟的瘘管。二期通畅率分别为 96%和 91%，1 年和 4 年时。即刻总体临床成功率为 97%。2 例失败均发生在未成熟和血栓形成的瘘管。即刻并发症包括 2 例短暂扩张引起的破裂，通过延长球囊充气进行治疗。1 例随后发生的手部缺血成功通过远端动脉结扎治疗。
血管内治疗在桡动脉和贵要静脉瘘的成熟过程、维持和挽救中发挥着重要作用。为未来保留上臂静脉，同时降低手部缺血或高流量的风险，可能会鼓励肾病学家和外科医生在血管通路创建策略中系统地考虑前臂贵要静脉瘘。
