Department of Surgery, Vascular Access Center, Shaare Zedek Medical Center, Jerusalem, Israel.
J Vasc Surg. 2010 Aug;52(2):495-8. doi: 10.1016/j.jvs.2010.01.096. Epub 2010 Apr 10.
Dialysis-associated steal syndrome with rest pain and ischemic nonhealing ulcers dictates prompt surgical intervention. Distal revascularization with interval ligation is extensive surgery for frail patients in whom calcified distal arteries make anastomosis difficult. Simple banding is appropriate in high-flow fistulas. In low-flow accesses, further flow reduction by simple banding may result in inadequate dialysis and cause thrombosis. However, banding between puncture sites maintains a pressure gradient between the arterial and venous puncture sites that enables adequate flow with effective hemodialysis that would not be possible with banding at the anastomosis. This new technique is a good solution for maintaining access patency and increasing digital pressure while avoiding complicated surgical revisions in high-risk patients.
透析相关窃血症伴静息痛和缺血性不愈性溃疡需要及时手术干预。对于虚弱的患者，由于远端动脉钙化导致吻合困难，采用间隔结扎的远端血运重建是一种广泛的手术。对于高流量瘘管，单纯束带术是合适的。在低流量通路中，单纯束带术进一步减少流量可能导致透析不足并导致血栓形成。然而，在穿刺部位之间束带可以维持动脉和静脉穿刺部位之间的压力梯度，从而实现足够的流量和有效的血液透析，而在吻合处束带则不可能实现。这种新技术是一种很好的解决方案，可以在避免高风险患者复杂手术修订的情况下，保持通路通畅性和增加指压，同时避免复杂的手术修订。
