Jeong Hyuncheol, Bae Miju, Chung Sung Woon, Lee Chung Won, Huh Up, Kim Min Su
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea.
Korean J Thorac Cardiovasc Surg. 2020 Feb;53(1):28-33. doi: 10.5090/kjtcs.2020.53.1.28. Epub 2020 Feb 5.
When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions.
Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed.
Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days).
Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.
当使用贵要静脉或头静脉深层创建动静脉内瘘（AVF）时，还需要将血管转移到易于穿刺的位置；然而，由于传统的深层AVF或贵要静脉转位导致手术切口长，许多患者会出现与伤口相关的术后并发症。因此，为了解决这个问题，我们进行了小手术切口的视频辅助手术。
回顾性分析了2018年在我院接受AVF形成术后额外视频辅助桡动脉头静脉浅层化、头臂静脉浅层化和肱贵要静脉转位的16例患者的数据。
所有患者穿刺均成功。未发生与伤口相关的并发症。首次穿刺前AVF的平均血管直径和血流量分别为0.73±0.16mm和1516.25±791.26mL/min。术后平均血管深度为0.26±0.10cm。25%的患者额外进行了经皮血管成形术。随访期间（262.44±73.49天）100%的患者观察到原发性通畅。
AVF的视频辅助手术显著降低了术后并发症的发生率，且不影响通畅性；此外，此类手术可能会增加自体血管用于血管通路的使用率。此外，与仅使用跳跃切口的盲目解剖相比，使用视频辅助进行解剖通过减少对解剖血管的损伤显著提高了移位成功率。
