Cerqueira Sofia S G, Ferreira Joana M, Fructuoso Mónica R, Eusebio Catarina, Castro Rui A, Morgado Teresa M
Centro Hospitalar Trás-os-Montes e Alto Douro, Hospital de Vila Real, Serviço de Nefrologia, Vila Real, Portugal.
Hospital da Senhora da Oliveira, Serviço de Angiologia e Cirurgia Vascular, Guimarães, Portugal.
J Bras Nefrol. 2021 Jan-Mar;43(1):41-46. doi: 10.1590/2175-8239-JBN-2020-0046.
A well-functioning vascular access is vital to patients on regular hemodialysis. Banding the access is indicated in high-flow-associated steal syndrome. It allows for the reduction of access flow while maintaining distal limb perfusion. Nonetheless, this procedure has some limitations as it can cause hemorrhage, infection, aneurysm formation, thrombosis of access in cases of overbanding, or otherwise insufficient reduction of vascular flow. Other surgical techniques to achieve the same benefit would be useful.
We performed a modified banding technique without endovascular placement of the angioplasty balloon, which is a viable alternative to other techniques. This surgery was performed in patients on chronic dialysis with steal syndrome. Pre- and post-operative access flows were measured and resolution of symptoms was recorded. Primary patency rate was defined as the intervention-free access survival from the operative time.
We verified that this technique allowed for access flow reduction in all our six patients, with total resolution of symptoms in all patients. Primary patency rate at 12 months was 100%. No major complications were noted during our follow-up.
This technique allows for correction of high-flow arteriovenous fistulas in an efficient and safe way, and can be a viable alternative to other banding procedures.
良好的血管通路对于定期进行血液透析的患者至关重要。在高流量相关的窃血综合征中，对血管通路进行绑扎是有必要的。它可以在维持肢体远端灌注的同时减少血管通路的血流量。然而，该手术存在一些局限性，因为它可能导致出血、感染、动脉瘤形成，在绑扎过度的情况下会导致血管通路血栓形成，或者无法充分减少血管流量。其他能达到相同效果的手术技术将很有用。
我们实施了一种改良的绑扎技术，无需在血管内放置血管成形术球囊，这是一种可替代其他技术的可行方法。该手术在患有窃血综合征的慢性透析患者中进行。测量术前和术后的血管通路血流量，并记录症状的缓解情况。主要通畅率定义为从手术时间起无干预的血管通路存活情况。
我们证实该技术在我们所有六名患者中都能减少血管通路血流量，所有患者的症状都完全缓解。12个月时的主要通畅率为100%。在我们的随访期间未发现重大并发症。
该技术能够以高效且安全的方式矫正高流量动静脉内瘘，并且可以成为其他绑扎手术的可行替代方法。
