Lei Wenhui, Ji Jiansong, Wang Jian, Jin Lie, Zou Hai
From the Department of Nephrology (WL, LJ); Department of Radiology, Lishui Hospital of Zhejiang University, Zhejiang Province (JJ); Department of Vascular and Endovascular Surgery, Lishui hospital of Zhejiang University, China (JW); and Department of Emergency, The Fourth Affiliated Hospital Zhejiang University, Yiwu, People's Republic China (HZ).
Medicine (Baltimore). 2015 Oct;94(41):e1645. doi: 10.1097/MD.0000000000001645.
In the present study, we performed an arterioarterial prosthetic loop (AAPL) between the femoral artery and deep femoral artery as a new access in patients who did not have adequate vascular conditions for creating an arteriovenous fistula or graft.Between April 2005 and June 2014, 18 patients received AAPL as a vascular access. During the procedure, a polytetrafluoroethylene graft was anastomosed to the femoral artery and deep femoral artery and looped on the thigh. We assessed the reliability and safety of AAPLs by analyzing complication, primary and secondary patency rates, and postoperative blood flow.Eighteen patients (median age, 66 years; range, 43-96 years) underwent AAPL access placement under the general or local anesthesia. All patients were followed up for 3 to 38 months (mean, 24 months). Primary and secondary patency rates at 6 months were 94.5% and 88.8%, respectively, and at 3 years were 61% and 72%, respectively. After operation, one patient had infection, and another one had fat necrosis at the surgical incision site. To maintain the AAPL function, 5 surgical procedures in 4 grafts, including revision, thrombectomy, excision, and repair for bleeding were performed. More than 5000 hemodialyses were performed efficiently in our center.Our study shows that AAPL loop is an unusual but effective and safe procedure that may be a good alternative for the patients who do not allow the conventional hemodialysis access.
在本研究中，对于那些没有足够血管条件来建立动静脉内瘘或移植物的患者，我们进行了股动脉与股深动脉之间的动脉-动脉人工血管环（AAPL）作为一种新的血管通路。在2005年4月至2014年6月期间，18例患者接受了AAPL作为血管通路。手术过程中，将一段聚四氟乙烯移植物吻合至股动脉和股深动脉，并在大腿上形成血管环。我们通过分析并发症、初次和二次通畅率以及术后血流量来评估AAPL的可靠性和安全性。18例患者（中位年龄66岁；范围43 - 96岁）在全身或局部麻醉下接受了AAPL血管通路置入。所有患者均随访3至38个月（平均24个月）。6个月时的初次和二次通畅率分别为94.5%和88.8%，3年时分别为61%和72%。术后，1例患者发生感染，另1例患者手术切口部位出现脂肪坏死。为维持AAPL功能，对4条移植物进行了5次外科手术，包括翻修、取栓、切除以及出血修复。我们中心高效地进行了超过5000次血液透析。我们的研究表明，AAPL血管环是一种不常见但有效且安全的手术方法，对于那些不适合传统血液透析血管通路的患者可能是一个很好的替代选择。
