Department of Vascular Surgery, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Vascular Surgery, 83011Hospital de Navarra, Madrid, Spain.
Vasc Endovascular Surg. 2023 Feb;57(2):149-153. doi: 10.1177/15385744221131426. Epub 2022 Oct 4.
Despite the lack of calcification, to perform a native Arteriovenous Fistula (AVF) in young patients may pose a challenge due to small vessel diameter. We report a case series with no options of AVF in which vessel caliber improvement after isometric exercise allowed for radiocephalic fistula creation in all of them.
Since 2017 to 2019, four patients were referred to our unit to create an AVF. Following a first assessment with physical examination and doppler ultrasound, none of them were eligible for AVF performance due to small vessel caliber. Once they were considered unsuitable for it, they started an isometric exercise program.
Age ranged from 13 to 19 years. There were three males and one female. Two were in predialysis and two in hemodialysis program. Initial diameters of the forearm cephalic vein and the radial artery respectively were: case A < 1.5/2.3 mm, case B 1.5/1.6 mm, case C < 1.5/1.6 mm and case D 2.1/1.3 mm. Median duration of exercise program was 13 weeks (range 5-23). Post-exercise vessel diameters were: case A 2.7/2.3 mm, case B 2.5/2 mm, case C 2.8/1.8 mm and case D 2.7/2 mm. Radiocephalic AVF were performed in the four cases. After a median follow up of 19 months (range 9-30 months), 75% of patients required further interventions but all of them had a functional AVF.
In these four cases isometric preoperative exercise allowed the creation of AVF. Without the improvement in vessel diameter observed afterwards, all of them would have been rejected for AVF performance. Despite the high rate of adjunctive interventions needed, given the safety of the program and the potential risks of Central Venous Catheters, we consider it a valuable option.
尽管没有钙化，但由于血管直径较小，对于年轻患者进行原生动静脉瘘（AVF）可能具有挑战性。我们报告了一系列病例，这些患者均无 AVF 选择，在这些患者中，等长运动后血管口径的改善使得桡动脉-头静脉瘘得以创建。
自 2017 年至 2019 年，有 4 名患者被转至我们科室创建 AVF。在进行体格检查和多普勒超声检查的初步评估后，由于血管口径较小，他们均不符合 AVF 适应证。一旦被认为不适合进行 AVF，他们就开始进行等长运动计划。
年龄范围为 13 至 19 岁，男性 3 例，女性 1 例。2 例在透析前，2 例在血液透析方案中。前臂头静脉和桡动脉的初始直径分别为：病例 A <1.5/2.3mm，病例 B 1.5/1.6mm，病例 C <1.5/1.6mm，病例 D 2.1/1.3mm。运动方案的中位持续时间为 13 周（范围 5-23 周）。运动后的血管直径为：病例 A 2.7/2.3mm，病例 B 2.5/2mm，病例 C 2.8/1.8mm，病例 D 2.7/2mm。这 4 例均进行了桡动脉-头静脉瘘。中位随访 19 个月（范围 9-30 个月）后，75%的患者需要进一步干预，但所有患者均有功能型 AVF。
在这 4 例患者中，术前等长运动使 AVF 得以创建。如果没有观察到血管直径的改善，他们都将被拒绝进行 AVF 治疗。尽管需要进行高比例的辅助干预，但考虑到该方案的安全性和中心静脉导管的潜在风险，我们认为这是一种有价值的选择。
