Jennings William C, Maliska Charles Miles, Blebea John, Taubman Kevin E
Department of Surgery, University of Oklahoma College of Medicine, Tulsa, Oklahoma - USA.
J Vasc Access. 2016 May 7;17(3):239-42. doi: 10.5301/jva.5000507. Epub 2016 Feb 5.
Central venous obstruction Occlusion (CVO) has been considered a contraindication for creating a vascular access due to fear of developing a swollen extremity. However, many of these individuals developed large collateral veins and are asymptomatic. We report our experience constructing arteriovenous fistulas (AVFs) in these challenging patients.
Patients with a new AVF constructed in the presence of known CVO were identified. Venous imaging confirmed proximal obstruction and extensive collateral venous return. The AVF was constructed in the extremity with the most favorable ultrasound vessel mapping and collateral central venous outflow. Arterial inflow via the radial artery was utilized when feasible.
AVFs associated with known CVO were constructed in 19 patients during an eight-year time period. The mean age was 53 years, 63% were female, and 58% diabetic. Arterial inflow was from the radial artery in 15 patients and the brachial or axillary artery in 5 individuals. Post-operative AVF flow volumes were 415-910 mL/min (mean = 640 mL/min). Eight patients (42%) developed some degree of arm edema. Two resolved without intervention. The others required inflow banding (n = 2), outflow branch coiling (n = 1), and/or recanalization with angioplasty (n = 4) of the CVO to resolve swelling. Mean follow-up was 14 months. Two AVFs failed at 8 and 16 months. Primary and cumulative patency rates were 49% and 100% at 12 months and 39% and 80% at 24 months, respectively.
CVO need not preclude the creation of a successful AVF. Extensive venous collaterals and avoiding high-flow AVFs are important elements for success. Cumulative patency was 80% at 24 months.
由于担心出现肢体肿胀，中心静脉阻塞（CVO）一直被视为建立血管通路的禁忌证。然而，这些患者中有许多人形成了粗大的侧支静脉且无症状。我们报告在这些具有挑战性的患者中构建动静脉内瘘（AVF）的经验。
确定在已知CVO情况下构建新AVF的患者。静脉成像证实近端阻塞和广泛的侧支静脉回流。在超声血管造影显示最有利且有中心静脉侧支流出的肢体构建AVF。可行时采用经桡动脉的动脉流入。
在8年期间，为19例患者构建了与已知CVO相关的AVF。平均年龄53岁，63%为女性，58%患有糖尿病。15例患者的动脉流入来自桡动脉，5例来自肱动脉或腋动脉。术后AVF血流量为415 - 910 mL/分钟（平均 = 640 mL/分钟）。8例患者（42%）出现了一定程度的手臂水肿。2例未经干预自行缓解。其他患者需要对CVO进行流入道结扎（n = 2）、流出道分支线圈栓塞（n = 1）和/或血管成形术再通（n = 4）以缓解肿胀。平均随访14个月。2个AVF分别在8个月和16个月时失败。12个月时的初次通畅率和累积通畅率分别为49%和100%，24个月时分别为39%和80%。
CVO并不一定妨碍成功构建AVF。广泛的静脉侧支以及避免高流量AVF是成功的重要因素。24个月时的累积通畅率为80%。
