Gallagher James J, Boniscavage Pamela, Ascher Enrico, Hingorani Anil, Marks Natalie, Shiferson Alexander, Jung Daniel, Jimenez Robert, Novak Daniel, Jacob Theresa
Maimonides Medical Center, Brooklyn, NY, USA.
Ann Vasc Surg. 2012 Oct;26(7):982-4. doi: 10.1016/j.avsg.2012.01.009. Epub 2012 Jun 26.
To examine the effect of office-based duplex-guided balloon-assisted maturation (DG-BAM) on arteriovenous fistula (AVF), we retrospectively analyzed our experience.
Over the past 10 months, we performed 185 DG-BAMs (range, 1-8 procedures; mean, 3.7) in 45 patients (29 male, 16 female; mean age, 68.2 ± 12.8 years) with 31 radial-cephalic, 7 brachial-cephalic, and 7 brachial-basilic AVFs. Balloon sizes (3-10 mm) were chosen based on duplex measurements (1-2 mm larger than minimal vein diameter). Forearm AVFs were dilated to 8 mm, and arm AVFs were dilated to 10 mm.
All cases but one (99.5%) were successfully dilated. This exception was a large AVF rupture that required surgical repair. AVFs failed to mature in seven of the remaining 44 patients (16%) despite DG-BAM because of proximal vein stenoses (PVS). Four patients had cephalic arch stenoses, and three had proximal subclavian vein stenoses. Arm AVFs were more commonly associated with PVS (6 of 14 patients, 43%) as compared with the ones placed in the forearm (1 of 30 patients, 3.3%), with a P value of 0.0024. All these seven AVFs subsequently matured after successful balloon angioplasty of the venous outflow.
These data suggest that office-based DG-BAM of AVFs is feasible, safe, and averts nephrotoxic contrast and radiation. PVS appear to be the most common cause of failure for AVFs subjected to BAM. Because arm AVFs are at increased risk of PVS, we suggest that a careful duplex evaluation of the outflow be performed in these cases and in all AVFs that fail to mature.
为研究基于诊室的双功超声引导下球囊辅助成熟术（DG-BAM）对动静脉内瘘（AVF）的影响，我们回顾性分析了我们的经验。
在过去10个月中，我们对45例患者（29例男性，16例女性；平均年龄68.2±12.8岁）的31例桡动脉-头静脉、7例肱动脉-头静脉和7例肱动脉-尺静脉AVF进行了185次DG-BAM操作（范围为1-8次操作；平均3.7次）。根据双功超声测量结果（比最小静脉直径大1-2mm）选择球囊尺寸（3-10mm）。前臂AVF扩张至8mm，上臂AVF扩张至10mm。
除1例（99.5%）外，所有病例均成功扩张。该例外情况为1例大型AVF破裂，需要手术修复。在其余44例患者中，尽管进行了DG-BAM，但仍有7例（16%）AVF未成熟，原因是近端静脉狭窄（PVS）。4例患者存在头臂弓狭窄，3例患者存在近端锁骨下静脉狭窄。与前臂AVF（30例患者中的1例，3.3%）相比，上臂AVF更常与PVS相关（14例患者中的6例，43%），P值为0.0024。在成功对静脉流出道进行球囊血管成形术后，所有这7例AVF随后均成熟。
这些数据表明，基于诊室的AVF的DG-BAM是可行、安全的，并且避免了肾毒性造影剂和辐射。PVS似乎是接受BAM的AVF失败的最常见原因。由于上臂AVF发生PVS的风险增加，我们建议在这些病例以及所有未成熟的AVF中对流出道进行仔细的双功超声评估。
