Chipde Saurabh Sudhir, Agrawal Santosh, Kalathia Jaisukh, Mishra Udit, Agrawal Rajeev
Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
Saudi J Kidney Dis Transpl. 2017 Mar-Apr;28(2):336-340. doi: 10.4103/1319-2442.202781.
Primary use of the autogenous arteriovenous access is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines. In spite of troublesome comorbidities associated with basilic vein transposition (BVT), it is still the most preferred technique when autologous veins are not suitable to construct radio-cephalic fistula (RCF) and brachiocephalic fistula (BCF), arteriovenous fistula (AVF). The present study highlights our experience with BVT, with small incision technique, over a period of two years with excellent outcome. This retrospective study included all the patients who underwent BVT at our tertiary care center between March 2013 and March 2015. It was performed in patients with failed previous RCF or BCF or who had small caliber or thrombosed cephalic veins. The patients with minimum 3 mm basilic vein diameter on Doppler were only included in the study. A 3-cm horizontal incision was made in antecubital fossa to expose brachial artery and basilic vein. Multiple longitudinal separate second skin incisions (2-3 cm) were made to explore proximal part of basilic vein. Side branches of the vein were isolated and ligated. The divided basilic vein in antecubital fossa was brought over fascia through newly created subcutaneous tunnel followed by end-to-side anastomosis. A total of 18 (12 males and 6 females) underwent BVT in the two years period. The mean fistula maturation time was 42 ± 10 days. Maturation rate was 100%, and the postoperative flow rate was 290 ± 22 (mL/min). No bleeding, thrombosis, failure, pseudo aneurysm, or rupture occurred in our patients. Arm edema occurred in ix (33%) patients, infection in three (17%), and lymphorrhea in five (28%). The mean follow-up was six months. BVT is an alternative method with excellent initial maturation and functional patency rates requiring less extensive skin incision and surgical dissection. It is the most durable hemodialysis access procedure for those patients having multiple forearm AVF surgeries.
美国国家肾脏基金会-透析预后质量倡议指南推荐首选自体动静脉内瘘。尽管贵要静脉转位术（BVT）存在一些麻烦的合并症，但当自体静脉不适合构建桡动脉-头静脉内瘘（RCF）和肱动脉-头静脉内瘘（BCF）即动静脉内瘘（AVF）时，它仍是最优选的技术。本研究重点介绍了我们采用小切口技术进行BVT的两年经验，结果良好。这项回顾性研究纳入了2013年3月至2015年3月期间在我们三级医疗中心接受BVT的所有患者。该手术适用于先前RCF或BCF失败、头静脉管径小或血栓形成的患者。仅将多普勒检查显示贵要静脉直径至少为3 mm的患者纳入研究。在肘前窝做一个3 cm的水平切口，以暴露肱动脉和贵要静脉。做多个纵向分开的第二皮肤切口（2 - 3 cm）以探查贵要静脉近端。分离并结扎静脉的侧支。将肘前窝处切断的贵要静脉通过新创建的皮下隧道拉至筋膜上方，然后进行端侧吻合。在两年期间共有18例（12例男性和6例女性）接受了BVT。平均内瘘成熟时间为42±10天。成熟率为100%，术后血流量为290±22（mL/分钟）。我们的患者未发生出血、血栓形成、内瘘失败、假性动脉瘤或破裂。9例（33%）患者出现手臂水肿，3例（17%）发生感染，5例（28%）出现淋巴漏。平均随访时间为6个月。BVT是一种替代方法，初始成熟率和功能通畅率良好，所需皮肤切口和手术分离范围较小。对于那些接受过多次前臂AVF手术的患者来说，它是最持久的血液透析通路手术。
