Szewczyk Dariusz, Bojakowski Krzysztof, Kasprzak Dominika, Kaźmierczak Stanisław, Piasecki Antoni, Andziak Piotr
2nd Department of Vascular Surgery and Angiology, Medical Centre of Postgraduate Education, Warsaw, Poland.
2nd Department of Vascular Surgery and Angiology, Medical Centre of Postgraduate Education, Warsaw, Poland.
Ann Vasc Surg. 2019 Nov;61:356-362. doi: 10.1016/j.avsg.2019.04.047. Epub 2019 Jul 31.
Achieving well-functioning dialysis fistulas is a common problem in dialyzed patients, and it is mainly caused by the pathologies of vessels used for fistula creation. Hybrid therapies, combining surgical and endovascular procedures, potentially enable the creation of functional dialysis fistulas in patients with vessels that are otherwise unsuitable for vascular access.
Between January 1, 2014 and June 30, 2018, we created dialysis fistulas simultaneously with endovascular correction of outflow pathologies in 15 patients. The included patients had a long history of dialysis (median 10.5 years, range 3-22) and many previous dialysis access procedures (mean 5.3 procedures, range 2-9). In 13 patients (86.7%), the fistula was created on the upper arm; in 5 patients (33.3%), it was arteriovenous graft done with polytetrafluoroethylene (PTFE) prosthesis (in an additional 3 patients, a PTFE prosthesis was used to extend the vein), and 7 patients had native vessel fistulas (46.7%). Endovascular procedures, in some cases performed on more than 1 vein, were applied for correction of the subclavian vein (8 patients, 53.3%); brachiocephalic vein (6 patients, 40.0%); cephalic, basilic, and axillary veins (2 patients each, 13.3%); and superior cava vein (1 patient, 6.7%). Access for the endovascular procedure was achieved through a dissected vein used for arteriovenous anastomosis. The fistula function was monitored, and all complications of dialysis access were noted. The median follow-up in the observed group was 18 months. We compared the patency of dialysis fistula creation combined with endovascular correction of outflow vein pathology to our results of standard dialysis fistula operations: radiocephalic dialysis fistula creation (RCAVF group, 65 patients) and dialysis fistula stenosis angioplasty (PTA group, 30 patients).
The 12- and 24-month primary patency rates of dialysis fistulas created in hybrid procedures with simultaneous outflow vein pathology correction were 72.7% and 63.6%, respectively. No early complications related to endovascular or open procedures were observed.
A hybrid procedure for the creation of a dialysis fistula with the simultaneous correction of outflow pathologies enables a properly functioning dialysis fistula to be obtained. This procedure can be performed in patients with complicated vascular situations, enabling the creation of dialysis fistulas. Our results of hybrid procedures, involving simultaneous endovascular correction of the outflow vein with dialysis fistula creation, showed the efficiency and good results.
建立功能良好的透析内瘘是透析患者的常见问题，主要由用于建立内瘘的血管病变引起。将外科手术和血管内介入手术相结合的混合治疗方法，有可能为血管条件不适合建立血管通路的患者建立起功能性透析内瘘。
在2014年1月1日至2018年6月30日期间，我们为15例患者在进行血管内流出道病变矫正的同时建立了透析内瘘。纳入的患者透析病史较长（中位数为10.5年，范围3 - 22年），且之前进行过多次透析通路手术（平均5.3次，范围2 - 9次）。13例患者（86.7%）的内瘘建立在上臂；5例患者（33.3%）使用聚四氟乙烯（PTFE）人工血管进行动静脉移植（另外3例患者使用PTFE人工血管延长静脉），7例患者建立了自体血管内瘘（46.7%）。血管内介入手术在某些情况下对不止1条静脉进行，用于矫正锁骨下静脉（8例患者，53.3%）；头臂静脉（6例患者，40.0%）；头静脉、贵要静脉和腋静脉（各2例患者，13.3%）；以及上腔静脉（1例患者，6.7%）。血管内介入手术的入路通过用于动静脉吻合的解剖静脉实现。监测内瘘功能，并记录透析通路的所有并发症。观察组的中位随访时间为18个月。我们将透析内瘘建立联合流出静脉病变的血管内矫正的通畅率与我们标准透析内瘘手术的结果进行比较：桡动脉 - 头静脉内瘘建立（RCAVF组，65例患者）和透析内瘘狭窄血管成形术（PTA组，30例患者）。
在同时进行流出静脉病变矫正的混合手术中建立的透析内瘘，其12个月和24个月的初级通畅率分别为72.7%和
