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俯卧位有助于建立尺侧-贵要静脉动静脉内瘘。

Prone Position Facilitates Creation of Ulnar-Basilic Arteriovenous Fistula.

作者信息

Gołębiowski Tomasz, Jerzak Patryk, Letachowicz Krzysztof, Konieczny Andrzej, Kusztal Mariusz, Gołębiowski Maciej, Banasik Mirosław, Sznajder Katarzyna, Krajewska Magdalena

机构信息

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.

Department of Radiology, University of Opole, 45-052 Opole, Poland.

出版信息

J Clin Med. 2022 May 6;11(9):2610. doi: 10.3390/jcm11092610.

DOI:10.3390/jcm11092610
PMID:35566736
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9100111/
Abstract

BACKGROUND

The distal ulnar-basilic arteriovenous fistula (UBAVF) is a rarely used alternative type of vascular access for haemodialysis. The location of the vein on the back aspect of the forearm forces an extremely uncomfortable external rotation of the upper limb during surgery when the patient is in a supine position.

METHODS

We present a new approach towards creating UBAVF, which involves placing the patient in the prone position, thus eliminating the aforementioned inconvenience. The procedure was performed and described in a 46-year-old patient with chronic kidney disease (CKD) due to diabetic nephropathy. In the period from September 2021 to December 2021, we created an additional three UBAVFs with such modifications.

RESULTS

All fistulas were patent both immediately after the procedure and 2 weeks after surgery.

CONCLUSIONS

The prone position may improve the comfort of both the operator and the patient during the procedure. On top of this, it may have a positive impact on the quality of the arteriovenous anastomosis.

摘要

背景

尺动脉-贵要静脉远端动静脉内瘘(UBAVF)是一种很少使用的血液透析血管通路替代类型。在前臂背侧的静脉位置使得患者仰卧位手术时上肢会出现极其不适的外旋。

方法

我们提出了一种创建UBAVF的新方法,即让患者处于俯卧位,从而消除上述不便。该手术在一名因糖尿病肾病导致慢性肾脏病(CKD)的46岁患者身上进行并描述。在2021年9月至2021年12月期间,我们通过这种改良方法又创建了另外3个UBAVF。

结果

所有内瘘在术后即刻及术后2周均通畅。

结论

俯卧位可能会提高手术过程中术者和患者的舒适度。除此之外,它可能对动静脉吻合质量产生积极影响。

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本文引用的文献

1
Ulnar-Basilic Arteriovenous Fistula for Hemodialysis Access: Utility as the "Second Procedure" after Radio Cephalic Fistula.用于血液透析通路的尺侧-贵要静脉动静脉内瘘:作为桡动脉-头静脉内瘘后的“二次手术”的效用
Ann Vasc Dis. 2021 Jun 25;14(2):132-138. doi: 10.3400/avd.oa.20-00124.
2
Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.透析起始、方式选择、通路和处方:肾脏病:改善全球预后组织(KDIGO)争议会议的结论。
Kidney Int. 2019 Jul;96(1):37-47. doi: 10.1016/j.kint.2019.01.017. Epub 2019 Apr 13.
3
Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).
编辑推荐——血管通路:欧洲血管外科学会(ESVS)2018年临床实践指南
Eur J Vasc Endovasc Surg. 2018 Jun;55(6):757-818. doi: 10.1016/j.ejvs.2018.02.001. Epub 2018 May 2.
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Spanish Clinical Guidelines on Vascular Access for Haemodialysis.西班牙血液透析血管通路临床指南。
Nefrologia. 2017 Nov;37 Suppl 1:1-191. doi: 10.1016/j.nefro.2017.11.004.
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Long-Term Results of Ulnar-Basilic Fistula Versus Radiocephalic Fistula for Maintenance Hemodialysis Access.尺侧-贵要静脉内瘘与桡动脉-头静脉内瘘用于维持性血液透析通路的长期效果
Vasc Endovascular Surg. 2017 Oct;51(7):466-469. doi: 10.1177/1538574417718448. Epub 2017 Aug 24.
6
Placement of wrist ulnar-basilic autogenous arteriovenous access for hemodialysis in adults and children using microsurgery.成人和儿童采用显微外科技术行腕部尺桡动脉-头静脉自体动静脉内瘘置管。
J Vasc Surg. 2011 May;53(5):1298-302. doi: 10.1016/j.jvs.2010.10.116. Epub 2011 Jan 26.
7
Native forearm fistulas utilizing the basilic vein: an underused type of vascular access.利用贵要静脉的自体前臂动静脉内瘘:一种未得到充分利用的血管通路类型。
J Nephrol. 2008 May-Jun;21(3):363-7.
8
Ulnar-basilic fistula: indications, surgical aspects, puncture technique, and results.尺侧-贵要静脉内瘘:适应证、手术要点、穿刺技术及结果
Artif Organs. 2004 Jul;28(7):634-8. doi: 10.1111/j.1525-1594.2004.07370.x.
9
Access to circulation by permanent arteriovenous fistula in regular dialysis treatment.在常规透析治疗中通过永久性动静脉内瘘建立血液循环通路。
Br Med J. 1967 Dec 9;4(5579):586-9. doi: 10.1136/bmj.4.5579.586.
10
Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula.采用静脉穿刺和外科造瘘进行慢性血液透析。
N Engl J Med. 1966 Nov 17;275(20):1089-92. doi: 10.1056/NEJM196611172752002.