Jennings William C, Blebea John, Arcos V Karlos, Maliska Miles, Fadner Brandon, Nguyen Albert
University of Oklahoma-Tulsa, College of Medicine, Department of Surgery, Tulsa, OK 74135, USA.
J Vasc Access. 2012 Oct-Dec;13(4):508-12. doi: 10.5301/jva.5000085.
The standard lengthy surgical incision used for basilic vein arteriovenous fistula (AVF) transposition is associated with significant discomfort, scarring and risk of wound complications. Minimally invasive vein dissection using a laryngoscope is an inexpensive alternative which has been successfully used for saphenous vein harvesting and which we have applied to the basilic vein for laryngoscopic-assisted AVF transposition (L-AVF/T).
During this technique, the basilic vein is mobilized through two small incisions, one in the axilla and the second just proximal to the cubital fossa. Ultrasound examination is used to map the location of the largest distal venous branch, either the forearm basilic vein or the median cubital vein. An important element of exposure is incising the superficial investing fascia longitudinally over the vein, allowing the working space to expand.
L-AVF/Ts were constructed in 47 patients during a 20 month time period. Mean age was 62 (18-87) years. Twenty-five (53%) patients were women, sixteen (34%) were obese and twenty-eight (60%) were diabetic. All veins were successfully harvested and there were no neurologic injuries. Primary and cumulative patency rates were 80% and 92%, respectively, at one year with follow-up ranging between 1-20 months (mean = 4 months).
Minimally invasive dissection of the basilic vein for vascular access transposition using laryngoscopic assistance is safe, reliable and cost efficient with good short-term patency and functional outcomes.
用于贵要静脉动静脉内瘘（AVF）转位的标准长手术切口会带来明显不适、瘢痕形成及伤口并发症风险。使用喉镜进行微创静脉解剖是一种成本较低的替代方法，已成功用于大隐静脉采集，我们已将其应用于贵要静脉以进行喉镜辅助AVF转位（L-AVF/T）。
在此技术中，通过两个小切口游离贵要静脉，一个在腋窝，另一个在肘窝近端。使用超声检查来确定最大远端静脉分支的位置，即前臂贵要静脉或肘正中静脉。暴露的一个重要环节是在静脉上方纵向切开浅筋膜，以扩大操作空间。
在20个月的时间里，为47例患者构建了L-AVF/T。平均年龄为62岁（18 - 87岁）。25例（53%）患者为女性，16例（34%）肥胖，28例（60%）患有糖尿病。所有静脉均成功采集，无神经损伤。随访1至20个月（平均 = 4个月），一年时的一期通畅率和累积通畅率分别为80%和92%。
使用喉镜辅助对贵要静脉进行微创解剖以进行血管通路转位是安全、可靠且具有成本效益的，短期通畅率和功能结果良好。
