Department of Radiology, Kaohsiung Veterans General Hospital, Zuoying Dist, No.386, Ta-Chung 1 Rd, Kaohsiung, 81362, Taiwan ROC.
Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
Cardiovasc Intervent Radiol. 2024 Aug;47(8):1142-1147. doi: 10.1007/s00270-024-03804-y. Epub 2024 Jul 15.
Arteriovenous fistulas (AVF) is the preferred type of hemodialysis access, but when an arteriovenous anastomosis (AVA) calcifies, surgical revision of the AVF may be required. We report a technique to create percutaneous artery-to-vein intervascular neo-fistulas for re-anastomosis of AVA and evaluate its safety and efficacy.
9 patients who failed either guidewire navigation or conventional balloon dilation for calcified AVA stenosis/occlusion underwent a salvage procedure of their dialysis shunt by the percutaneous creation of a new arteriovenous fistula. Needle puncture of the adjacent supplying artery and outflow vein under ultrasonographic and/or fluoroscopic guidance was performed and followed by balloon dilation, with or without stent graft placement. The detailed techniques, technical success, primary neo-fistula patency, primary and secondary access patency rates were reported herein.
Technical success was achieved in 100% of the 9 patients treated (7 neo-fistulas with stents and 2 neo-fistulas without stent placement). The median primary neo-fistula and access patencies were 15 and 5 months, respectively. The primary neo-fistula patency rates at 6, 12, and 18 months were 72.9%, 54.7% and 27.9%, respectively, with secondary neo-fistula and access patency rates of 72.9%, 72.9% and 72.9%, respectively. One delayed complication of pseudoaneurysm formation occurred, which was managed by the successful endovascular deployment of a stent graft on an out-patient basis.
Percutaneous artery-to-vein intervascular neo-fistula creation is feasible for re-anastomosing calcified AVA, with low adverse effects and acceptable primary neo-fistula and secondary access patency.
动静脉瘘（AVF）是首选的血液透析通路，但当动静脉吻合（AVA）发生钙化时，可能需要对 AVF 进行手术修正。我们报告一种技术，用于创建经皮动脉-静脉血管间新瘘，以重新吻合 AVA，并评估其安全性和有效性。
9 例因 AVA 狭窄/闭塞行导丝导航或常规球囊扩张失败的患者，采用经皮创建新动静脉瘘的方法对其透析分流进行挽救性治疗。在超声和/或透视引导下，对邻近供血动脉和流出静脉进行针穿刺，然后进行球囊扩张，可放置或不放置支架移植物。本文报告了详细的技术、技术成功率、主要新瘘通畅率、主要和次要通路通畅率。
9 例患者（7 例带支架的新瘘和 2 例不带支架的新瘘）均达到技术成功。中位首次新瘘和通路通畅时间分别为 15 个月和 5 个月。6、12 和 18 个月时的首次新瘘通畅率分别为 72.9%、54.7%和 27.9%，其次是新瘘和通路的通畅率分别为 72.9%、72.9%和 72.9%。发生 1 例迟发性并发症假性动脉瘤形成，经成功的门诊血管内支架移植物植入术治疗。
经皮动脉-静脉血管间新瘘的创建可用于重新吻合钙化的 AVA，不良事件发生率低，首次新瘘和次级通路通畅率可接受。
