University Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
J Vasc Surg. 2011 Jul;54(1):168-73. doi: 10.1016/j.jvs.2010.12.050. Epub 2011 Mar 2.
We examined the outcomes of radiocephalic arteriovenous fistulas salvaged by formation of a neoanastomosis in the proximal cephalic vein segment.
Patients with a radiocephalic arteriovenous fistula revised by formation of a neoanastomosis in the proximal cephalic vein segment were identified from a prospectively maintained database and outcomes retrospectively analyzed.
Eighty patients had 81 radiocephalic arteriovenous fistulas revised by formation of a neoanastomosis in the proximal cephalic vein segment. Failure to mature was the indication for revision in 39 (48.1%), 17 (21.0%) were revised for poor flows during dialysis, and 25 (30.9%) were performed for thrombosis. Primary patency of the 81 neoanastomoses at 12, 24, and 36 months was 78.5%, 68.9%, and 54.9%, respectively. Compared with neoanastomoses that were performed on 50 immature radiocephalic arteriovenous fistulas, those performed on the 31 mature fistulas exhibited improved patency rates (P = .04). There was no difference in the primary patency of the neoanastomosis between those performed for 25 failed fistulas and 56 failing (but patent) fistulas (P = .15). There was one case (1.2%) each of bleeding, infection, and steal after neoanastomosis. Four patients (4.9%) required further interventions on their neoanastomoses.
Operative salvage of radiocephalic arteriovenous fistulas by formation of a neoanastomosis in the proximal cephalic vein segment demonstrates good patency and low complication rates and can be performed with reasonably good results in patients with failed or failing (but patent) radiocephalic arteriovenous fistulas. These patients should not automatically proceed to elbow fistula formation; rather, proximal neoanastomosis should be considered.
我们研究了通过在头静脉近段形成新吻合口来挽救头静脉动静脉瘘的结果。
从一个前瞻性维护的数据库中确定了通过在头静脉近段形成新吻合口来修复头静脉动静脉瘘的患者，并回顾性分析了其结果。
80 例患者的 81 个头静脉动静脉瘘通过在头静脉近段形成新吻合口进行了修复。39 例（48.1%）因不成熟而需要修复，17 例（21.0%）因透析时血流量差而需要修复，25 例（30.9%）因血栓形成而需要修复。81 个新吻合口的 12、24 和 36 个月的原发性通畅率分别为 78.5%、68.9%和 54.9%。与 50 个不成熟的头静脉动静脉瘘相比，在 31 个成熟的瘘中进行新吻合口的通畅率提高（P =.04）。在因 25 个失败的瘘和 56 个失败（但通畅）的瘘而进行的新吻合中，其通畅率没有差异（P =.15）。新吻合后有 1 例（1.2%）出血、1 例（1.2%）感染和 1 例（1.2%）窃血。4 例（4.9%）患者需要对新吻合口进行进一步干预。
通过在头静脉近段形成新吻合口来挽救头静脉动静脉瘘的手术治疗具有良好的通畅率和较低的并发症发生率，可以在失败或失败（但通畅）的头静脉动静脉瘘患者中取得较好的效果。这些患者不应该自动进行肘部瘘成形术；相反，应考虑近端新吻合术。
