Department of Angioaccess Surgery, Clinique, Jouvenet, Paris, France.
J Vasc Surg. 2011 May;53(5):1298-302. doi: 10.1016/j.jvs.2010.10.116. Epub 2011 Jan 26.
The distal basilic forearm vein is frequently preserved and might be used more frequently for placement of an ulnar-basilic autogenous arteriovenous access (UB-AAVA) in the wrist despite the small size of the two vessels. The scarcity of publications led us to initiate a prospective study regarding the placement and outcomes of UB-AAVAs.
Seventy patients (63 adults, seven children) with no usable cephalic vein in either forearm were selected consecutively over 4 years for placement of a UB-AAVA. The prerequisite was a clinically visible or palpable forearm basilic vein after placing a tourniquet. Regional anesthesia, prophylactic hemostasis, and a surgical microscope were used systematically. Secondary superficialization was performed in two patients. Most non-matured accesses were abandoned in favor of the placement of a more proximal autogenous access. Mean follow-up was 20 months (SD =15).
Immediate patency was obtained in 94% of adults and 100% of children. Success (in-use access) was achieved in 60% of patients (38/63 adults and 6/7 children) after a mean postoperative interval of 80 days (SD = 64; range, 31-277). Failures included four immediate thromboses, one postoperative death, and 21 never-matured accesses. No steal syndrome was observed. Initial failures included, primary patency rates in adults at 1 and 2 years were 42% ± 6% and 30% ± 7%, respectively; secondary patency rates at 1 year and 2 years were 60% ± 6% and 53% ± 7%, respectively.
Although patency rates are not as good as those achieved with radial cephalic-AAVA, the UB-AAVA is an alternative autogenous forearm access before the placement of any other access involving the basilic vein. The use of the surgical microscope is mandatory, and more than usual time is required to achieve maturation.
尽管尺骨下前静脉和贵要静脉的管径较小，但在前臂通常可以保留该静脉，因此，即使在前臂的头静脉无法使用的情况下，也可以更多地将其用于腕部贵要-尺骨内瘘（UB-AAVA）的建立。由于文献报道较少，我们开展了一项前瞻性研究，旨在探讨 UB-AAVA 的建立和结果。
4 年来，我们连续选择了 70 例（63 例成人，7 例儿童）前臂头静脉无法使用的患者，为其行 UB-AAVA 置管术。置管前先使用止血带，确保在前臂可见或可触及贵要静脉。我们系统地采用局部麻醉、预防性止血和手术显微镜。2 例患者行辅助浅化术。大多数不成熟的通路被放弃，转而建立更靠近近端的自体通路。平均随访 20 个月（标准差=15）。
成人和儿童的即时通畅率分别为 94%和 100%。术后 80 天（标准差=64；范围 31-277），63 例成人中有 38 例（60%）和 7 例儿童中有 6 例（60%）患者成功建立（正在使用的通路）。失败的原因包括 4 例即时血栓形成、1 例术后死亡和 21 例未成熟的通路。未观察到窃血综合征。初始失败包括，成人在 1 年和 2 年时的初始通畅率分别为 42%±6%和 30%±7%；2 年时的次级通畅率分别为 60%±6%和 53%±7%。
尽管通畅率不如桡动脉头静脉-AAVA，但在涉及贵要静脉的其他任何通路建立之前，UB-AAVA 是一种可供选择的自体前臂通路。必须使用手术显微镜，而且需要比通常更多的时间来实现成熟。
