Department of Traditional Chinese Medicine, The First Affiliated Hospital of Soochow University; Department of Nephrology, The First Affiliated Hospital of Soochow University; Department of Nephrology, Suzhou Science & Technology Town Hospital.
Department of Nephrology, Suzhou Science & Technology Town Hospital.
J Vis Exp. 2023 Feb 10(192). doi: 10.3791/64352.
Juxta-anastomotic stenosis is a challenging problem that often causes non-maturation and decreases the patency of an arteriovenous fistula (AVF). Injury to the veins and arteries during the operation and hemodynamic changes can lead to intimal hyperplasia, leading to juxta-anastomotic stenosis. To reduce injury to the veins and arteries during the operation, this study proposes a new modified no-touch technique (MNTT) for AVF construction that can decrease the rate of juxta-anastomotic stenosis and improve the AVF patency. To unravel the hemodynamic changes and mechanisms of the MNTT, this study presented an AVF procedure using this technique. Although this procedure is technically challenging, 94.4% procedural success was achieved after adequate training. Ultimately, 13 out of 34 rabbits had a functional AVF 4 weeks after the surgery, leading to a 38.2% AVF patency rate. However, at 4 weeks, the survival rate was 86.1%. Ultrasonography showed active blood flow through AVF anastomosis. Furthermore, the spiral laminar flow was observed in the vein and artery near the anastomosis, suggesting that this technique may improve the hemodynamics of the AVF. On histological observation, significant venous intimal hyperplasia was observed at the AVF anastomosis, whereas no significant intimal hyperplasia was observed at the proximal external jugular vein (EJV) of the anastomosis. This technique will improve the understanding of the mechanisms underlying the use of MNTT for AVF construction and provide technical support for the further optimization of the surgical approach in AVF construction.
吻合口狭窄是一个具有挑战性的问题，它经常导致动静脉瘘（AVF）不成熟和通畅率降低。手术过程中静脉和动脉的损伤以及血流动力学的变化可导致内膜增生，从而导致吻合口狭窄。为了减少手术过程中对静脉和动脉的损伤，本研究提出了一种新的改良无接触技术（MNTT）用于 AVF 构建，该技术可以降低吻合口狭窄的发生率，提高 AVF 的通畅率。为了解剖 MNTT 的血流动力学变化和机制，本研究采用该技术进行了 AVF 手术。虽然该手术技术具有挑战性，但经过充分的培训，术后 94.4%的手术获得成功。最终，34 只兔子中有 13 只在手术后 4 周时拥有功能正常的 AVF，通畅率为 38.2%。然而，4 周时的存活率为 86.1%。超声检查显示 AVF 吻合口处有活跃的血流。此外，在吻合口附近的静脉和动脉中观察到螺旋层流，表明该技术可能改善 AVF 的血流动力学。组织学观察显示，AVF 吻合口处有明显的静脉内膜增生，而吻合口近端的颈外静脉（EJV）处则没有明显的内膜增生。该技术将增进对 MNTT 用于 AVF 构建的机制的理解，并为进一步优化 AVF 构建的手术方法提供技术支持。
