Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan; Department of Vascular Surgery, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan.
J Vasc Surg. 2021 Jan;73(1):285-290. doi: 10.1016/j.jvs.2020.05.035. Epub 2020 May 28.
The objective of this study was to evaluate the outcome of a short interposition using a small-diameter prosthetic graft as a flow-limiting procedure to manage symptomatic high-flow arteriovenous fistula (AVF).
A retrospective review of medical records on a case series was conducted. From June 2004 to April 2017, there were 25 patients with clinical symptoms of high output cardiac failure and progressive dilation of aneurysmal fistula vein due to high-flow AVF (≥1.5 L/min) who underwent short interposition with a 5-mm prosthetic graft at Saitama Medical Center. The primary outcome was the relief of clinical symptoms; other outcome measures included technical success, surgical complications, patency of vascular access, and postoperative changes in local and systemic hemodynamics as assessed by Doppler ultrasound.
Twenty-five patients underwent short interposition for cardiac indications (n = 16) and aneurysmal dilation (n = 9). The technical success rate was 100%. The clinical symptoms were relieved in 24 patients (96.0%). Mean reduction in access blood flow was 52.4%. Cumulative primary unassisted patency rates (± standard error) at 1 year, 2 years, and 3 years were 76.2% ± 9.3%, 70.4% ± 10.3%, and 58.1% ± 11.6%, respectively. Secondary patency rates (± standard error) at 1 year, 2 years, and 3 years were 81.8% ± 8.2%, 71.5% ± 9.9%, and 71.5% ± 9.9%, respectively. Complications included access occlusion due to late thrombosis (n = 5 [21.7%]) and graft infection (n = 1 [4.3%]) in the median follow-up period of 3.9 years.
Short interposition with a prosthetic graft is a simple, effective, and durable treatment option for end-stage renal disease patients with cardiac symptoms and progressive dilation of the fistula vein due to high-flow AVF, offering clinical symptom resolution while preserving the autologous behavior of the initial access.
本研究旨在评估使用小直径假体移植物作为限流术治疗症状性高流量动静脉瘘（AVF）的效果。
对一系列病例的病历进行回顾性分析。2004 年 6 月至 2017 年 4 月期间，25 例因高流量 AVF（≥1.5 L/min）导致心力衰竭症状和动脉瘤样瘘静脉进行性扩张的患者在埼玉医疗中心接受了 5 毫米假体移植物的短间隔术。主要结果是缓解临床症状；其他结果测量包括技术成功率、手术并发症、血管通路通畅性以及术后多普勒超声评估的局部和全身血液动力学变化。
25 例患者因心脏原因（n=16）和动脉瘤样扩张（n=9）进行了短间隔术。技术成功率为 100%。24 例患者（96.0%）的临床症状得到缓解。通路血流量平均减少 52.4%。1 年、2 年和 3 年的累计初次非辅助通畅率（±标准误差）分别为 76.2%±9.3%、70.4%±10.3%和 58.1%±11.6%。1 年、2 年和 3 年的次级通畅率（±标准误差）分别为 81.8%±8.2%、71.5%±9.9%和 71.5%±9.9%。并发症包括中位随访 3.9 年后因迟发性血栓形成导致的通路闭塞（n=5 [21.7%]）和移植物感染（n=1 [4.3%]）。
对于因高流量 AVF 导致心脏症状和瘘静脉进行性扩张的终末期肾病患者，假体移植物短间隔术是一种简单、有效、持久的治疗选择，可缓解临床症状，同时保留初始通路的自体行为。
