1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain.
2 Vascular Surgery Department, Hospital Donostia, Spain.
J Endovasc Ther. 2019 Apr;26(2):213-218. doi: 10.1177/1526602819830983. Epub 2019 Feb 15.
To describe a maneuver to facilitate percutaneous arteriovenous fistula creation during venous arterialization procedures in patients with no-option critical limb ischemia.
Following a failed arterial recanalization attempt, a balloon catheter is passed up to the tip of the guidewire. Venous access is gained distally, a 4-F sheath is antegradely passed, and a 4-mm GooseNeck snare is advanced through it. A fluoroscopic view that overlaps the snare and the inflated balloon is obtained. If the vein remains anterior with respect to the artery, a needle is inserted across the vein, passing through the snare loop and puncturing the intra-arterial balloon. A wire is inserted and placed inside the punctured balloon. The balloon is retrieved and the wire externalized through the femoral access. A catheter is advanced antegradely over this wire from the artery into the vein. If the vein remains posterior to the artery, a needle is inserted, puncturing the balloon and thereafter the vein (crossing through the snare). A wire is inserted, captured by the snare, and externalized through the vein sheath. A catheter is finally advanced over this wire from the vein into the artery.
This maneuver is a simple alternative to create an arteriovenous fistula during venous arterialization procedures in patients with no-option critical limb ischemia.
描述一种在无选择的严重肢体缺血患者的静脉动脉化过程中，便于进行经皮动静脉瘘创建的操作方法。
在动脉再通尝试失败后，将球囊导管推送至导丝的尖端。经远端静脉入路，向前推送 4-F 鞘管，并通过鞘管推进 4 毫米 GooseNeck 套圈。获得重叠套圈和充气球囊的透视视图。如果静脉相对于动脉仍在前部，可将针穿过静脉穿过套圈环并刺穿动脉内球囊。插入导丝并将其置于穿刺的球囊内。取回球囊，并通过股动脉入路将导丝引出体外。从动脉向前推进导管，穿过导丝进入静脉。如果静脉仍位于动脉后方，可插入针，刺穿球囊，然后刺穿静脉（穿过套圈）。插入导丝，被套圈捕获，并通过静脉鞘管引出体外。最后，从静脉推进导管至动脉。
对于无选择的严重肢体缺血患者的静脉动脉化过程中，这种操作方法是创建动静脉瘘的一种简单替代方法。
