Donghua Gu, Zhen Liu, Xiaohe Wang, Guocun Hou, Lei Shen
Department of Pathology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China.
Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China.
J Vasc Access. 2025 May;26(3):1024-1031. doi: 10.1177/11297298241256172. Epub 2024 Jun 5.
To investigate the technical advantages of a modified no-touch technique (MNTT) in constructing arteriovenous fistulas (AVF) compared to the conventional technique (CT) and assess its potential to reduce neointimal hyperplasia in the outflow vein.
Forty-seven New Zealand rabbits were randomly divided into three groups: control, CT, and MNTT. Rabbits in control group were observed using ultrasound and then euthanized to obtain external jugular vein (EJV) for Hematoxylin-eosin (H-E). We established common carotid artery (CCA)-EJV AVF using MNTT in the MNTT group and the CT in the CT group. AVF patency and complications were compared between the CT and MNTT groups. Rabbits with patent AVF in both groups were observed using ultrasound 2 weeks after surgery to evaluate changes in the vessel diameter and blood flow spectrum of the AVFs. H-E staining measured the intima thickness of EJV adjacent to the anastomosis and histologic characteristics of the AVF at 2 and 4 weeks after surgery.
Five rabbits died after surgery with common symptoms of sneezing, coughing, runny nose, anorexia, and diarrhea; two in the MNTT group and three in the CT group. There were significant differences in the diameter ( = 0.010) and peak systolic velocities (PSV) ( = 0.001) of EJV between the CT and MNTT groups 2 weeks after surgery. Spiral laminar flow (SLF) was observed in CCA and EJV adjacent to anastomosis in the MNTT group. Additionally, histological observations showed less venous neointimal hyperplasia in the MNTT group than in the CT group 4 weeks after surgery.
The rabbit model of CCA-EJV AVF established using MNTT demonstrated fewer comlications, larger vein diameters, and reduced venous neointimal hyperplasia, indicating that this maybe an ideal animal model to further investigate the application of MNTT in AVF surgery.
探讨改良非接触技术（MNTT）在构建动静脉内瘘（AVF）方面相对于传统技术（CT）的技术优势，并评估其减少流出静脉新生内膜增生的潜力。
47只新西兰兔随机分为三组：对照组、CT组和MNTT组。对对照组兔子进行超声观察，然后实施安乐死以获取颈外静脉（EJV）用于苏木精-伊红（H-E）染色。MNTT组采用MNTT建立颈总动脉（CCA）-EJV AVF，CT组采用CT建立。比较CT组和MNTT组的AVF通畅情况及并发症。对两组中AVF通畅的兔子在术后2周进行超声观察，以评估AVF的血管直径和血流频谱变化。术后2周和4周，采用H-E染色测量吻合口附近EJV的内膜厚度及AVF的组织学特征。
5只兔子术后死亡，常见症状为打喷嚏、咳嗽、流鼻涕、厌食和腹泻；MNTT组2只，CT组3只。术后2周，CT组和MNTT组EJV的直径（=0.010）和收缩期峰值流速（PSV）（=0.001）存在显著差异。MNTT组吻合口附近的CCA和EJV观察到螺旋层流（SLF）。此外，组织学观察显示，术后4周MNTT组的静脉新生内膜增生少于CT组。
采用MNTT建立的CCA-EJV AVF兔模型并发症更少、静脉直径更大且静脉新生内膜增生减少，表明这可能是进一步研究MNTT在AVF手术中应用的理想动物模型。
