Mallios Alexandros, Jennings William, Costanzo Alessandro, Boura Benoit, Combes Myriam
1 Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
2 Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK, USA.
J Vasc Access. 2019 May;20(3):321-324. doi: 10.1177/1129729818798303. Epub 2018 Sep 6.
Ulnar-basilic arteriovenous fistula is an alternative option when a radiocephalic arteriovenous fistula is not feasible. We review our technique of basilic vein transposition in the upper arm for difficult to puncture forearm ulnar-basilic non-transposed arteriovenous fistulae.
Three patients were referred for forearm ulnar-basilic arteriovenous fistulae with difficult cannulation where the forearm basilic vein was left in situ (non-transposed). Surgeon performed ultrasound examination confirmed a patent arteriovenous fistula with adequate diameter and flow, draining to the basilic vein in the forearm and into the upper arm. Recurrent new and resolving hematomas were present surrounding the forearm basilic vein resulting from difficult cannulation issues and problems maintaining needle position due the posterior-medial ulnar-basilic arteriovenous fistula position and mobility of the non-transposed forearm basilic vein. A basilic vein transposition elevation procedure was performed in the upper arm starting at the level of the elbow to a few centimeters below the axilla. Branches of the dilated basilic vein were ligated, the median cutaneous nerve was preserved, and the vein was elevated from its native position to a superficial and anterior location. Although difficult, dialysis access had been continued in the forearm during a brief period and none required catheter placement. Reliable dialysis access was successfully initiated using the newly transposed basilic vein in the upper arm 3-4 weeks after the procedure, maintaining arterial inflow based on the original ulnar-basilic arteriovenous fistula anastomosis at the wrist. None of the patients required further interventions with follow-up of 8, 15, and 22 months.
当桡动脉-头静脉动静脉内瘘不可行时，尺动脉-贵要静脉动静脉内瘘是一种替代选择。我们回顾了我们在上臂进行贵要静脉转位的技术，用于难以穿刺的前臂尺动脉-贵要静脉未转位的动静脉内瘘。
三名患者因前臂尺动脉-贵要静脉动静脉内瘘插管困难前来就诊，前臂贵要静脉保留在原位（未转位）。外科医生进行超声检查，确认动静脉内瘘通畅，直径和血流量充足，从前臂贵要静脉引流至上臂。由于插管困难以及因尺动脉-贵要静脉动静脉内瘘位于前臂后内侧的位置和未转位的前臂贵要静脉的活动度导致难以维持针的位置，前臂贵要静脉周围反复出现新的和正在消退的血肿。在上臂进行了贵要静脉转位抬高手术，从肘部水平开始至腋窝下方几厘米处。结扎扩张的贵要静脉分支，保留正中皮神经，将静脉从其原始位置抬高至浅表和前方位置。尽管困难，但在短时间内前臂仍继续进行透析通路，且无人需要放置导管。术后3 - 4周成功使用上臂新转位的贵要静脉启动了可靠的透析通路，基于腕部原有的尺动脉-贵要静脉动静脉内瘘吻合维持动脉血流。在8、15和22个月的随访中，没有患者需要进一步干预。
