Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
Department of Angioaccess Surgery, Clinique Jouvenet, Paris, France.
J Vasc Access. 2021 Mar;22(2):238-242. doi: 10.1177/1129729820936921. Epub 2020 Jun 27.
We evaluate the creation of a percutaneous proximal radial artery-radial vein arteriovenous fistula with Ellipsys instead of the usual first-stage brachial artery fistula prior to a second-stage brachial vein elevation, in patients with inadequate cephalic and basilic veins.
Single center study of eight patients (six males, mean = 54 years) who underwent a two-stage brachial vein elevation procedure between May 2017 and October 2019. Inclusion criteria were life expectancy > 6 months, patent brachial and proximal radial artery (>2 mm in diameter) absent/inadequate cephalic and basilic veins, existence of a brachial vein >3 mm in diameter, and in continuity with a proximal radial vein > 2 mm in diameter.
Technical success was 100%. Four patients required angioplasty of a juxta-anastomotic stenosis, accounting for a 6-month primary and secondary patency rates were 68% and 100%, respectively. Access flow averaged 982 mL/min (range 768-1586) at final follow-up evaluation. There were no significant adverse events related to the procedures. All fistulae were elevated at 4-12 (mean: 8) weeks post creation and were successfully cannulated with two needles after healing was completed (2-4 weeks after elevation). No patients developed hand ischemia or arm edema.
Percutaneous creation of a proximal radial artery-radial vein fistula followed by brachial vein elevation is a safe and reliable option for autogenous access creation in patients with inadequate cephalic or basilic veins. Minimally invasive radial artery inflow and longer available length of the targeted brachial vein available for elevation are the main advantages in skilled hands.
我们评估了在第二期肱静脉抬高术之前，使用 Ellipsys 而非常规的一期肱动脉造瘘术，在头静脉和贵要静脉不足的患者中创建经皮近侧桡动脉-桡静脉动静脉瘘。
这是一项单中心研究，纳入了 2017 年 5 月至 2019 年 10 月期间接受两期肱静脉抬高术的 8 名患者（6 名男性，平均年龄 54 岁）。纳入标准为预期寿命>6 个月、肱动脉和近侧桡动脉通畅（直径>2mm）、头静脉和贵要静脉缺失/不足、存在直径>3mm 的肱静脉且与直径>2mm 的近侧桡静脉连续。
技术成功率为 100%。4 名患者需要行吻合口近侧狭窄球囊扩张术，6 个月时一期和二期通畅率分别为 68%和 100%。最终随访时，平均流量为 982mL/min（范围 768-1586）。无与手术相关的严重不良事件。所有瘘管在创建后 4-12 周（平均 8 周）抬高，愈合后（抬高后 2-4 周）用两根针成功穿刺。无患者发生手部缺血或手臂肿胀。
在头静脉或贵要静脉不足的患者中，经皮创建近侧桡动脉-桡静脉瘘，随后抬高肱静脉，是自体动静脉内瘘创建的一种安全可靠的选择。微创的桡动脉入路和可供抬高的目标肱静脉更长的可用长度是在熟练的术者手中的主要优势。
