Vaes Roel H D, van Loon Magda, Vaes Selma M M, Cuypers Philippe, Tordoir Jan H, Scheltinga Marc R
1 Department of Surgery, Máxima Medical Center, Veldhoven - The Netherlands.
J Vasc Access. 2015;16 Suppl 9:S96-101. doi: 10.5301/jva.5000357. Epub 2015 Mar 8.
Flow reduction is advised in hemodialysis (HD) patients with a high-flow (>2 L/min) arteriovenous fistula (AVF). The revision using distal inflow (RUDI) technique is based on the premise that access flow is attenuated once inflow is provided by a smaller caliber forearm artery. Aim of the study was to evaluate the efficacy of RUDI during a 1-year follow-up.
All HD patients undergoing a RUDI operation using a greater saphenous vein (GSV) or a basilic vein (BaV) interposition for a high-flow access (HFA, >2 L/min) during a 3.5-year time period were included. Serial access flow, percentage of freedom from recurrent high flow and complications were determined.
A total of 19 HFA patients were studied (11 males, age 55 ± 3 years). All AVFs were brachial artery based (brachiocephalic, n = 14; brachiobasilic, n = 5). RUDI immediately reduced access flow by almost 2 L/min (3,080 ± 200 to 1,170 ± 160 mL/min (p = 0.001)). Access flows at 1, 6 and 12 months were 1,150 ± 160, 1,460 ± 200 and 1,580 ± 260 mL/min, respectively. Postoperative complications included insufficient flow reduction (n = 1, BaV) and occlusion requiring revision (n = 1, GSV). Recurrent HFA occurred three times (n = 2 BaV, n = 1 GSV). Access flows were significantly (p<0.05) higher in the BaV group compared to the GSV group.
RUDI effectively reduces access flow in a brachial artery-based high-flow HD vascular access. A flow-reducing effect is sustained at 1-year follow-up in most patients. GSV is preferred as an interposition graft compared to a BaV.
对于动静脉内瘘（AVF）血流量高（>2L/min）的血液透析（HD）患者，建议减少血流量。使用远端流入（RUDI）技术进行修复的前提是，一旦由较小口径的前臂动脉提供流入血流，通路血流量就会衰减。本研究的目的是评估RUDI在1年随访期内的疗效。
纳入在3.5年期间所有接受RUDI手术的HD患者，这些患者使用大隐静脉（GSV）或贵要静脉（BaV）搭桥以建立高血流量通路（HFA，>2L/min）。测定系列通路血流量、避免复发性高血流量的百分比以及并发症情况。
共研究了19例HFA患者（11例男性，年龄55±3岁）。所有AVF均基于肱动脉（头臂型，n=14；肱贵要型，n=5）。RUDI立即使通路血流量降低近2L/min（从3080±200降至1170±160mL/min，p=0.001）。1个月、6个月和12个月时的通路血流量分别为1150±160、1460±200和1580±260mL/min。术后并发症包括血流量减少不足（n=1，BaV）和需要修复的闭塞（n=1，GSV）。复发性HFA发生3次（n=2，BaV；n=1，GSV）。与GSV组相比，BaV组的通路血流量显著更高（p<0.05）。
RUDI可有效降低基于肱动脉的高血流量HD血管通路的血流量。大多数患者在1年随访期内血流量降低效果持续存在。与BaV相比，GSV作为搭桥移植物更受青睐。
