Mirabella Domenico, Dinoto Ettore, Rodriquenz Edoardo, Bellomo Michele, Miccichè Andrea, Annicchiarico Paolo, Pecoraro Felice
Vascular Surgery Unit, AOUP Policlinico "P. Giaccone", 90127 Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy.
Biomedicines. 2024 May 2;12(5):1005. doi: 10.3390/biomedicines12051005.
In patients with end-stage renal failure requiring hemodialysis, autogenous arteriovenous fistula (AVF) is preferred over tunneled dialysis catheters due to lower complications and costs. However, AVF maturation failure remains a common issue due to small vein size, multiple venipunctures, and other factors. Guidelines recommend using vessels of >2 mm for forearm AVFs and >3 mm for upper arm AVFs. This study investigates the use of intraoperative Doppler ultrasound (DUS)-guided Balloon-Assisted Maturation (BAM) with drug-eluting balloons (DEB) during initial AVF creation. Data from 114 AVF procedures, of which 27.2% underwent BAM, were analyzed. BAM was performed in 25 distal radio-cephalic and 6 proximal brachio-cephalic AVFs. With DUS guidance, vein stenosis was identified and treated using DEB. Technical success was achieved in all cases, with no early mortality. Early BAM-related complications were minimal, and no AVF thrombosis occurred. AVF maturation time was 15 days (SD: 3), and no further complications were reported during a mean follow-up of 10.38 months. Using BAM with DEB during AVF creation led to successful maturation and dialysis use without the need for secondary procedures. This study emphasizes the importance of identifying AVF failure risk early and utilizing DUS-guided procedures to enhance AVF outcomes. A more liberal use of intraoperative BAM could limit reinterventions in patients undergoing AVFs.
在需要进行血液透析的终末期肾衰竭患者中，由于并发症和成本较低，自体动静脉内瘘（AVF）比隧道式透析导管更受青睐。然而，由于静脉管径小、多次静脉穿刺及其他因素，AVF成熟失败仍是一个常见问题。指南建议前臂AVF使用直径>2 mm的血管，上臂AVF使用直径>3 mm的血管。本研究调查了在初次建立AVF期间使用术中多普勒超声（DUS）引导的球囊辅助成熟术（BAM）及药物洗脱球囊（DEB）的情况。分析了114例AVF手术的数据，其中27.2%接受了BAM。在25例远端桡动脉-头静脉和6例近端肱动脉-头静脉AVF中进行了BAM。在DUS引导下，识别静脉狭窄并使用DEB进行治疗。所有病例均取得技术成功，无早期死亡。早期与BAM相关的并发症极少，未发生AVF血栓形成。AVF成熟时间为15天（标准差：3天），在平均10.38个月的随访期间未报告进一步并发症。在AVF建立过程中使用带DEB的BAM可实现成功成熟并用于透析，无需二次手术。本研究强调了早期识别AVF失败风险并利用DUS引导程序改善AVF结局的重要性。更广泛地使用术中BAM可减少接受AVF手术患者的再次干预。
