Gołębiowski Tomasz, Weyde Wacław, Letachowicz Krzysztof, Kusztal Mariusz, Augustyniak-Bartosik Hanna, Penar Jan, Madziarska Katarzyna, Zmonarski Sławomir, Krajewska Magdalena, Klinger Marian
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw - Poland.
Fresenius Medical Care Polska, Poznań - Poland.
J Vasc Access. 2017 Sep 11;18(5):384-389. doi: 10.5301/jva.5000761. Epub 2017 Jul 26.
Creation of an arteriovenous fistula (AVF) in patients with advanced atherosclerotic changes of the artery is often a challenge for the physician due to difficulties in suturing the vein to the side of the frangible artery. The sleeve technique relies on advancing the end of the artery into the lumen of the vein and protecting the anastomosis by adventitial sutures.
The sleeve technique was performed in 23 patients with chronic kidney disease stage IV and V and included hemodialysis patients. Their mean age was 60.8 ± 14.8 years and hemodialysis treatment time 49.8 ± 40.2 months. The most frequent causes of chronic kidney disease are ischemic nephropathy (43%, n = 10) and type l diabetes (21%, n = 5). Only patients with extremely advanced atherosclerotic were recruited and analyzed.
The primary patency rate was 67%, 59%, 44% and 28% at 6, 12, 24, and 36 months, respectively. The secondary patency rate was 67%, 61%, 50% and 37% at 6, 12, 24, and 36 months, respectively. In three patients the AVF failed directly after the operation. Delayed fistula failure occurred in seven patients. The overall success in the creation of a functioning fistula was achieved in 15 of the 23 patients (65%). No serious complications were observed.
In patients with calcified atherosclerotic plaques, which constitute a barrier or make it difficult to suture the vein to the side of the artery, the sleeve method may be considered as an alternative before abandoning the creation of a fistula on the forearm. The technique is much simpler than the standard end-to-side or side-to-side anastomosis.
对于动脉存在晚期动脉粥样硬化改变的患者，由于难以将静脉缝合至脆弱的动脉侧壁，创建动静脉内瘘（AVF）对医生来说通常是一项挑战。套管技术依靠将动脉末端推进静脉腔内，并通过外膜缝合来保护吻合口。
对23例慢性肾脏病IV期和V期患者（包括血液透析患者）实施了套管技术。他们的平均年龄为60.8±14.8岁，血液透析治疗时间为49.8±40.2个月。慢性肾脏病最常见的病因是缺血性肾病（43%，n = 10）和I型糖尿病（21%，n = 5）。仅纳入并分析了动脉粥样硬化极其严重的患者。
6个月、12个月、24个月和36个月时的初次通畅率分别为67%、59%、44%和28%。6个月、12个月、24个月和36个月时的二次通畅率分别为67%、61%、50%和37%。3例患者术后AVF直接失败。7例患者发生内瘘延迟失败。23例患者中有15例（65%）成功创建了有功能的内瘘。未观察到严重并发症。
对于存在钙化动脉粥样硬化斑块、构成障碍或使静脉难以缝合至动脉侧壁的患者，在放弃在前臂创建内瘘之前，可考虑采用套管法作为一种替代方法。该技术比标准的端侧或侧侧吻合术要简单得多。
