Kohiyama Mayumi, Hoffstaetter Tabea, Silpe Jeffrey, Garlapati Avinash, Landis Gregg S, Etkin Yana
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Division of Vascular and Endovascular Surgery, Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
J Vasc Surg Cases Innov Tech. 2023 Feb 21;9(2):101133. doi: 10.1016/j.jvscit.2023.101133. eCollection 2023 Jun.
Balloon-assisted maturation (BAM) of arteriovenous fistulas has conventionally been performed via direct fistula access. The transradial approach has not been well described for BAM, although its use has been reported throughout the cardiology literature. The purpose of the present study was to assess the outcomes of transradial access for its use with BAM. A retrospective review of 205 patients with transradial access for BAM was performed. One sheath was inserted into the radial artery distal to the anastomosis. We have described the procedural details, complications, and outcomes. The procedure was considered technically successful if transradial access had been established and the AVF had been ballooned with at least one balloon without major complications. The procedure was considered clinically successful if no further interventions had been required for AVF maturation. The average time for BAM via transradial access was 35 ± 20 minutes, with 31 ± 17 mL of contrast used. No access-related perioperative complications, including access site hematoma, symptomatic radial artery occlusion, or fistula thrombosis, had occurred. The technical success rate was 100%, and the rate of clinical success was 78%, with 45 patients requiring additional procedures to achieve maturation. Transradial access is an efficient alternative to trans-fistula access for BAM. It is technically easier and allows for better visualization of the anastomosis.
动静脉内瘘的球囊辅助成熟术（BAM）传统上是通过直接的内瘘通路进行的。尽管在整个心脏病学文献中已有经桡动脉途径的使用报道，但对于BAM的经桡动脉途径尚未有详细描述。本研究的目的是评估经桡动脉途径用于BAM的效果。对205例行BAM经桡动脉途径的患者进行了回顾性分析。在吻合口远端的桡动脉中插入一个鞘管。我们描述了操作细节、并发症和结果。如果成功建立了经桡动脉途径且至少用一个球囊对动静脉内瘘进行了扩张且无重大并发症，则该操作在技术上被认为是成功的。如果动静脉内瘘成熟无需进一步干预，则该操作在临床上被认为是成功的。经桡动脉途径进行BAM的平均时间为35±20分钟，使用的造影剂为31±17毫升。未发生与通路相关的围手术期并发症，包括穿刺部位血肿、有症状的桡动脉闭塞或内瘘血栓形成。技术成功率为100%，临床成功率为78%，45例患者需要额外的操作来实现成熟。经桡动脉途径是BAM的经内瘘途径的一种有效替代方法。它在技术上更容易，并且能更好地观察吻合口。
