Etkin Yana, Silpe Jeffrey, Mussa Firas F, Talathi Sonia, Garuthara Melissa, Landis Gregg S
Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Division of Vascular Surgery, Department of Surgery, Montefiore Medical Centre, Bronx, NY, USA.
EJVES Vasc Forum. 2021 Nov 1;53:26-29. doi: 10.1016/j.ejvsvf.2021.10.017. eCollection 2021.
Vascular access induced digital ischaemia is an uncommon complication of haemodialysis access procedures and is difficult to manage. Several techniques have been described to treat this phenomenon, with variable long term success. Although all of these procedures have been shown to work, they have a significant failure rate, such as persistent high vascular access flow or loss of access. One of the major technical limitations of these techniques is the lack of quantitative data gathered during the procedure to ensure treatment success. In this study, the aim was to describe a novel technique that can improve the success of banding in preserving access and eliminating digital ischaemia.
A modified method for arteriovenous fistula banding that incorporates measurements of distal arterial pressure to improve the success of the procedure is described.
Sixteen patients with vascular access induced digital ischaemia and high-flow vascular access were treated using the technique. All procedures were technically successful. At 30 days, complete symptomatic relief (clinical success) was seen in 81% (n = 13) of patients. There was no access thrombosis or infection in any of the patients at the 30 day follow up. Six month follow up data were available in seven patients. There was no loss of access patency or recurrence of symptoms observed at six months.
This novel technique is simple and effective and can be used safely as first line therapy for the management of vascular access induced digital ischaemia.
血管通路引起的手指缺血是血液透析通路手术中一种罕见的并发症，且难以处理。已经描述了几种治疗这种现象的技术，长期成功率各不相同。尽管所有这些手术都已证明有效，但它们有显著的失败率，如血管通路持续高流量或通路丧失。这些技术的主要技术局限性之一是在手术过程中缺乏用于确保治疗成功的定量数据。在本研究中，目的是描述一种能够提高绑扎术在保留通路和消除手指缺血方面成功率的新技术。
描述了一种改良的动静脉内瘘绑扎方法，该方法结合了远端动脉压测量以提高手术成功率。
16例血管通路引起手指缺血且血管通路高流量的患者采用该技术进行治疗。所有手术在技术上均获成功。30天时，81%（n = 13）的患者症状完全缓解（临床成功）。在30天随访时，所有患者均未发生通路血栓形成或感染。7例患者有6个月的随访数据。6个月时未观察到通路通畅性丧失或症状复发。
这种新技术简单有效，可安全地用作治疗血管通路引起手指缺血的一线疗法。
