两阶段贵要静脉转位术——小儿血液透析通路的新方法。

Two-stage basilic vein transposition-a new approach for pediatric dialysis access.

机构信息

Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The CS Mott Children's Hospital, Ann Arbor, MI, USA.

出版信息

J Pediatr Surg. 2010 Jan;45(1):177-84; discussion 184. doi: 10.1016/j.jpedsurg.2009.10.029.

DOI:10.1016/j.jpedsurg.2009.10.029

PMID:20105601

Abstract

PURPOSE

The fistula first initiative has led to increased efforts to create arteriovenous fistulas (AVFs) as primary dialysis access. Two-stage basilic vein transposition (BVT) allows maturation of smaller veins, often a limiting factor in the pediatric population, before elevation and use. We sought to determine whether using 2-stage BVT improves maturation, use, and patency compared with other AVFs, including arteriovenous (AV) grafts.

METHODS

Thirty-one patients underwent AV access creation between 1997 and 2008. Data were collected on types of access, maturation, complications, and patency.

RESULTS

Forty-two AV access procedures were performed: 15 (36%) 2-stage BVT, 13 (31%) 1-stage BVT, 6 (14%) radiocephalic, 3 (7%) brachiocephalic, 1 (2%) brachiobrachial, and 4 (10%) AV grafts. Follow-up averaged 20.4 +/- 3.2 months for 2-stage BVT and 47.9+/-4.1 months for other AVFs (P < .001). All 2-stage BVT matured compared with 52% (14/27) of other AVFs (P = .001). More 2-stage BVTs (87%) were used for dialysis than other AVFs (48%, P = .024). Fistula failure occurred in 7% 2-stage BVT compared with 59% other AVFs (P = .001). One-year patency rates were 91% for 2-stage BVT vs 47% for other AVFs (P = .003).

CONCLUSIONS

Rates of fistula maturation, use, and patency are higher for 2-stage BVT with lower rates of failure. Two-stage BVT shows great promise as the preferred approach to creation of AVF in pediatric patients, especially those with smaller veins.

摘要

目的

fistula first 倡议促使人们加大力度创建动静脉瘘（AVF）作为主要透析通路。二期肱静脉转位术（BVT）可使较小的静脉成熟，这在儿科人群中常常是一个限制因素，然后再将其提升并使用。我们试图确定与其他动静脉（AV）移植物等其他 AVF 相比，使用两阶段 BVT 是否能改善成熟度、使用率和通畅率。

方法

1997 年至 2008 年间，31 例患者接受了血管通路的建立。收集了通路类型、成熟度、并发症和通畅率的数据。

结果

共进行了 42 次 AV 通路手术：15 例（36%）为两阶段 BVT，13 例（31%）为单阶段 BVT，6 例（14%）为桡动脉-头静脉，3 例（7%）为肱动脉-头静脉，1 例（2%）为肱动脉-肱静脉，4 例（10%）为 AV 移植物。两阶段 BVT 的平均随访时间为 20.4+/-3.2 个月，其他 AVF 为 47.9+/-4.1 个月（P<.001）。所有两阶段 BVT 均成熟，而其他 AVF 的成熟率为 52%（14/27）（P=.001）。与其他 AVF（48%，P=.024）相比，更多的两阶段 BVT（87%）用于透析。两阶段 BVT 的瘘管失败率为 7%，而其他 AVF 为 59%（P=.001）。两阶段 BVT 的 1 年通畅率为 91%，而其他 AVF 为 47%（P=.003）。