Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
J Vasc Access. 2021 Jul;22(4):555-560. doi: 10.1177/1129729820946643. Epub 2020 Aug 27.
Endovascular balloon angioplasty is standard therapy for dysfunctional arteriovenous fistula in end-stage renal failure patients on hemodialysis. Venous antegrade or retrograde puncture of the fistula is typically performed to gain access for fistuloplasty. Transradial approach for brachiocephalic or brachiobasilic arteriovenous fistulas offers an alternative method of access with the advantage of addressing multi-focal juxta-anastomotic and venous stenosis from the same approach. We aim to review the efficacy, outcomes and complication rates of transradial access for arteriovenous fistuloplasty among patients in Singapore.
A retrospective review of 195 endovascular fistuloplasties from September 2017 to August 2019, at a tertiary university hospital Vascular Surgery unit.
Of 195 fistuloplasties, 43 (22%) were transradial approach (23 brachiocephalic arteriovenous fistulas, 20 brachiobasilic arteriovenous fistulas) in 33 patients (67% male and mean age = 65 years). Of these 43 procedures, 11 (26%) were performed as balloon-assisted maturation fistuloplasties while 32 (74%) were performed for mature arteriovenous fistulas with multi-focal juxta-anastomosis and venous stenosis. Technical success rate was 95% with mean procedure duration at 43.5 ± 14.6 min. Mean pre- and post-fistuloplasty dialysis access flow rates increased from 502 to 952 ml/min (p < 0.001). Post-intervention primary patency was 100%, 66% and 20% at 1, 6 and 12 months, respectively. There were four patients with non-limb-threatening radial artery thrombosis (9.3%) while there was no radial artery pseudoaneurysm or post-procedural bleeding.
Transradial approach for arteriovenous fistuloplasty is a safe and feasible option in patients requiring balloon-assisted maturation or with multi-focal juxta-anastomotic and venous stenosis.
腔内球囊血管成形术是终末期肾衰竭血液透析患者功能失调动静脉瘘的标准治疗方法。通常通过瘘管的顺行或逆行静脉穿刺来获得瘘管成形术的通路。经桡动脉入路治疗头臂干或肱动脉-肱动脉动静脉瘘提供了一种替代的入路方法，其优点是可以从同一入路解决多处吻合口附近和静脉狭窄的问题。我们旨在回顾新加坡患者经桡动脉入路行动静脉瘘成形术的疗效、结果和并发症发生率。
回顾性分析 2017 年 9 月至 2019 年 8 月在一家三级大学医院血管外科进行的 195 例腔内动静脉瘘成形术。
195 例瘘管成形术中，33 例患者（67%为男性，平均年龄 65 岁）采用经桡动脉入路（23 例头臂干动静脉瘘，20 例肱动脉-肱动脉动静脉瘘），共 43 例（22%）。这 43 例中，11 例（26%）为球囊辅助成熟瘘管成形术，32 例（74%）为多处吻合口附近和静脉狭窄的成熟动静脉瘘。技术成功率为 95%，平均手术时间为 43.5±14.6 分钟。动静脉瘘透析血流量术前和术后分别为 502ml/min 和 952ml/min（p<0.001）。术后 1、6 和 12 个月的一期通畅率分别为 100%、66%和 20%。有 4 例（9.3%）患者发生非肢体威胁性桡动脉血栓形成，无桡动脉假性动脉瘤或术后出血。
对于需要球囊辅助成熟或存在多处吻合口附近和静脉狭窄的患者，经桡动脉入路行动静脉瘘成形术是一种安全可行的选择。
