超声引导下无切口环扎治疗血液透析动静脉内瘘高流量。
An ultrasound-guided no incision banding method for the treatment of arteriovenous fistula high-flow in hemodialysis.
机构信息
Department of Nephrology, Tongji Hospital of Tongji medical college of Huazhong University of Science and Technology, Wuhan, China.
Department of Hematology and Nephropathy, Xishui People's Hospital, Huanggang City, China.
出版信息
Ren Fail. 2023 Dec;45(1):2222853. doi: 10.1080/0886022X.2023.2222853.
OBJECTIVE
High-flow vascular access is one of the serious complications in the maturation and subsequent use of arteriovenous fistula (AVF). We adopted a novel surgical approach named no incision limited ligation indwelling needle assisted- revision (NILLINR) to treat high-flow of the hemodialysis vascular access and ascertained the outcomes by regular follow-up visits.
METHODS
This is a retrospective study. 26 hemodialysis patients with symptomatic high-flow access (access flow > 1500 mL/min) were treated with the novel banding method without incision between June 2018 and October 2020. The flow of the brachial artery before and after the restriction was measured by experienced clinicians by using the duplex Doppler ultrasound (DUS). All 26 patients were followed up for up to 1 year. Meanwhile, the brachial artery flow was recorded at 6 months and 1 year after restriction.
RESULTS
Of all 26 patients included in this study, the mean access flow volume decreased from 2196.2 ± 416.9 mL/min (mean ± SD) to 679.2 ± 67.1 mL/min immediately after the operation. During the follow-up, the volume flow of the brachial artery was still within the restricted range at 6 months (mean ± SD, 720.2 ± 164.7 mL/min) and 1 year (mean ± SD, 713.9 ± 173.8 mL/min) after the operation. Meanwhile, the mean duration of the operation is 8.5 ± 3.3 min, and there is no bleeding or rupture.
CONCLUSION
This novel no-incision limited ligation indwelling needle-assisted revision is a safe, effective, and time-saving option to treat high-flow access.
目的
高流量血管通路是动静脉瘘（AVF）成熟和后续使用过程中的严重并发症之一。我们采用了一种名为无切口有限结扎留置针辅助修复（NILLINR）的新手术方法来治疗血液透析血管通路的高流量，并通过定期随访来确定治疗效果。
方法
这是一项回顾性研究。2018 年 6 月至 2020 年 10 月，我们采用新型的无切口捆绑方法治疗了 26 例有症状的高流量通路（通路流量>1500mL/min）患者。经验丰富的临床医生使用双功能超声（DUS）测量肱动脉在限制前后的流量。所有 26 例患者均随访 1 年。同时，在限制后 6 个月和 1 年记录肱动脉流量。
结果
本研究共纳入 26 例患者，术后即刻通路流量从 2196.2±416.9mL/min（均值±标准差）降至 679.2±67.1mL/min。随访期间，术后 6 个月（均值±标准差，720.2±164.7mL/min）和 1 年（均值±标准差，713.9±173.8mL/min）时，肱动脉流量仍在限制范围内。同时，手术平均时间为 8.5±3.3min，无出血或破裂。
结论
这种新型无切口有限结扎留置针辅助修复术是治疗高流量通路的一种安全、有效、省时的选择。
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