Jang Jihoon, Jung Heekyung, Cho Jayun, Kim Jihye, Kim Hyung-Kee, Huh Seung
Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Vasc Specialist Int. 2014 Jun;30(2):62-7. doi: 10.5758/vsi.2014.30.2.62. Epub 2014 Jun 30.
Our study aims to evaluate to evaluate clinical outcomes after cephalic vein transposition (CVT) to the axilla in patients with brachiocephalic arteriovenous fistula (BC-AVF) and cephalic arch stenosis (CAS).
Hospital records of 13 patients (median age, 61 years; males, 54%) who received CVT to the proximal basilic/axillary vein due to either dysfunction (n=2) or thrombosis (n=11) between January 2010 and February 2014 were retrospectively reviewed.
Operation was performed under local anesthesia in all cases. There was no technical failure. Concomitant inflow procedure (banding or aneurysmorrhaphy) was performed in 5 patients (38%). During follow-up (1 to 50 months, median 17 months), 3 patients died with functioning AVF and one was successfully transplanted. Two patients suffered from recurrent symptomatic stenosis of AVF and received percutaneous balloon angioplasty. Another 2 patients experienced AVF occlusion treated with interposition graft and manual fragmentation. Overall primary, assisted primary, and secondary patency rates were 77.5%, 92.3%, and 100% at 6 months and 66.1%, 92.3%, and 100% at 1 year, respectively.
Although most patients presented with BC-AVF occlusion, technical success and access patency rates after CVT were favorable compared with historical data for interventional treatment. CVT should be considered as an appropriate option in selected patients with CAS.
我们的研究旨在评估头臂动静脉瘘（BC-AVF）合并头臂静脉弓狭窄（CAS）患者行头静脉转位至腋窝（CVT）后的临床结局。
回顾性分析2010年1月至2014年2月期间13例患者（中位年龄61岁；男性占54%）的医院记录，这些患者因功能障碍（n = 2）或血栓形成（n = 11）接受了头静脉转位至近端贵要静脉/腋静脉的手术。
所有病例均在局部麻醉下进行手术。无技术失败情况。5例患者（38%）同时进行了流入道手术（绑扎或动脉瘤缝合术）。在随访期间（1至50个月，中位时间17个月），3例患者在动静脉瘘功能良好时死亡，1例成功接受移植。2例患者出现复发性有症状的动静脉瘘狭窄并接受了经皮球囊血管成形术。另外2例患者的动静脉瘘闭塞，分别接受了间置移植和手动破碎治疗。6个月时的总体初级通畅率、辅助初级通畅率和次级通畅率分别为77.5%、92.3%和100%，1年时分别为66.1%、92.3%和100%。
尽管大多数患者存在BC-AVF闭塞，但与介入治疗的历史数据相比，CVT后的技术成功率和通路通畅率良好。对于选定的CAS患者，应考虑将CVT作为一种合适的选择。
