Jennings William C, Miller Gregg A, Coburn M Zachary, Howard C Anthony, Lawless Michael A
Department of Surgery, College of Medicine, University of Oklahoma-Tulsa, Tulsa, OK 74135, USA.
J Vasc Access. 2012 Apr-Jun;13(2):157-62. doi: 10.5301/jva.5000020.
Vascular access patients with central vein (CV) stenosis or occlusion may have significant symptoms. Treatment is generally by balloon angioplasty, with or without stenting. However, CV lesions may not be correctable and when treated, tend to recur. Surgical bypass of CV obstruction is a major procedure and ligation of the access may leave the patient dependent on catheter dialysis. We review a precision inflow banding procedure to limit vascular access flow and pressure for symptomatic patients with CV obstruction while preserving access functionality.
All individuals with symptomatic CV occlusive disease who underwent an autogenous vascular access inflow restriction procedure by the two senior authors were identified. All had failed attempts to correct CV lesions by angioplasty and stent placement. A precision banding procedure was used for access inflow reduction with the addition of real-time intravascular flow monitoring.
Twenty-two patients were identified. Ages were 22-72 years (mean=43 years). Nine patients (40.9%) were women, and 8 (36.4%) obese. Mean access flow was 1640 mL/minute before banding decreased to 820 mL/minute after banding (P< .01). All patients had access salvage. Swelling resolved promptly in 20 patients and was markedly improved in two individuals. Three patients underwent aneurysm repair with simultaneous inflow banding and decreased intra-access pressure after flow restriction. Two fistulas failed at eight and 13 months. Mean follow-up was 8 months.
The symptoms of hemodialysis vascular access patients associated with non-correctable central venous lesions resolved successfully and their access was maintained using a precision inflow banding procedure.
患有中心静脉（CV）狭窄或闭塞的血管通路患者可能会出现明显症状。治疗通常采用球囊血管成形术，可选择是否置入支架。然而，CV病变可能无法纠正，且治疗后容易复发。CV梗阻的外科搭桥手术是一项大型手术，结扎血管通路可能会使患者依赖导管透析。我们回顾了一种精确的流入带扎手术，该手术可在保留通路功能的同时，限制有CV梗阻症状患者的血管通路血流量和压力。
确定了所有由两位资深作者进行自体血管通路流入限制手术的有症状CV闭塞性疾病患者。所有患者通过血管成形术和支架置入纠正CV病变的尝试均失败。采用精确带扎手术减少通路流入量，并增加实时血管内血流监测。
共确定22例患者。年龄为22 - 72岁（平均43岁）。9例（40.9%）为女性，8例（36.4%）肥胖。带扎前平均通路血流量为1640毫升/分钟，带扎后降至820毫升/分钟（P <.01）。所有患者的通路均得以挽救。20例患者肿胀迅速消退，2例明显改善。3例患者在进行动脉瘤修复的同时进行了流入带扎，血流限制后通路内压力降低。2例瘘管分别在8个月和13个月时失败。平均随访8个月。
与不可纠正的中心静脉病变相关的血液透析血管通路患者的症状通过精确的流入带扎手术成功缓解，且通路得以维持。
