Department of Vascular and Endovascular Surgery, 29142MS Ramaiah Medical College, Bengaluru, Karnataka, India.
Asian Cardiovasc Thorac Ann. 2022 Jun;30(5):524-531. doi: 10.1177/02184923211041502. Epub 2021 Sep 8.
To maintain the patency and longevity of arteriovenous fistula, the availability of a venous segment with adequate diameter is important. In Indian population, many chronic kidney disease patients have poor caliber veins. The study aimed to evaluate the efficacy of hydrostatic dilatation versus Primary balloon angioplasty of small caliber cephalic veins of (≤2.5 mm) preoperatively in terms of patency rate and maturation time of arteriovenous fistula.
Patients ( = 80) with an end-stage renal disease requiring arteriovenous access surgery for hemodialysis with small caliber cephalic veins were randomized into two groups, i.e., hydrostatic dilatation and primary balloon angioplasty, each with 40 patients. All patients underwent a thorough clinical examination as well as duplex ultrasound vein mapping of both upper extremities. Patients were followed up for six months and primary patency, maturation time, and complications were noted.
Immediate technical success with good palpable thrill was achieved in 97.5% of patients in the primary balloon angioplasty group and 87.5% in the hydrostatic dilatation group. The fistula maturation time in the primary balloon angioplasty group was 34.41 days and 46.18 days in the hydrostatic dilatation group. In the primary balloon angioplasty group, the primary patency of the fistula was 97.5% and 87.5% in the hydrostatic dilatation group, at six months. The arteriovenous fistula functioning rate was 77.5% in the hydrostatic dilatation group as compared to 92.5% in the primary balloon angioplasty group at six months. The incidence of surgical site infection was 5% in the primary balloon angioplasty group as compared to 10% in the hydrostatic dilatation group.
Primary balloon angioplasty of small caliber cephalic veins (≤2.5 mm) performed prior to arteriovenous fistula creation for hemodialysis is a beneficial procedure.
为了维持动静脉瘘的通畅和寿命，有足够直径的静脉段是很重要的。在印度人群中，许多慢性肾脏病患者的静脉口径较小。本研究旨在评估术前静脉内静压扩张与原发性球囊血管成形术治疗（≤2.5mm）小口径头静脉在动静脉瘘通畅率和成熟时间方面的疗效。
将需要动静脉通路手术进行血液透析的终末期肾脏病患者（ = 80）随机分为两组，即静脉内静压扩张组和原发性球囊血管成形术组，每组 40 例。所有患者均行全面临床检查及双上肢多普勒超声静脉成像。对所有患者进行 6 个月的随访，记录动静脉瘘的通畅率、成熟时间及并发症。
原发性球囊血管成形术组患者 97.5%和静脉内静压扩张组患者 87.5%即刻获得技术成功，可触及震颤良好。原发性球囊血管成形术组瘘管成熟时间为 34.41 天，静脉内静压扩张组为 46.18 天。原发性球囊血管成形术组瘘管的初始通畅率为 97.5%，静脉内静压扩张组为 87.5%，均为 6 个月。静脉内静压扩张组动静脉瘘功能率为 77.5%，原发性球囊血管成形术组为 92.5%，均为 6 个月。原发性球囊血管成形术组手术部位感染发生率为 5%，静脉内静压扩张组为 10%。
在进行血液透析的动静脉瘘造瘘术前，对小口径（≤2.5mm）头静脉行原发性球囊血管成形术是一种有益的操作。
