多段球囊扩张技术建立小血管头臂自体动静脉内瘘的临床研究。
Clinical study on the establishment of radio-cephalic autogenous arteriovenous fistulas in small blood vessels by multi-segment balloon dilation technique.
机构信息
Department of Nephrology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China.
出版信息
Medicine (Baltimore). 2024 Sep 20;103(38):e39758. doi: 10.1097/MD.0000000000039758.
BACKGROUND
To investigate the effect of dilating small blood vessels using a balloon dilation (BD) technique on the occurrence of radio-cephalic autogenous arteriovenous fistulas in terms of patency, blood flow, and vein diameter (VD).
METHODS
The subjects included in this study were all patients with chronic renal failure and required radio-cephalic arteriovenous fistula surgery for the first time and had not received dialysis before. Patients with VDs <2 mm were included as study subjects. They were either assigned treatment using a BD group or a control group that received hydrostatic dilation. The differences between the 2 groups were analyzed in terms of patency, blood flow, and VD.
RESULTS
A total of 22 patients were enrolled in the balloon dilatation group and 20 patients in the control group. The diameters of cephalic veins (mm) of the experimental and control group were compared at various time points: immediately postoperation, 2.89 ± 0.42 versus 1.99 ± 0.28 (P < .001); 1 week later, 3.16 ± 0.59 versus 2.66 ± 0.60 (P = .022); 1 month later, 3.76 ± 0.91 versus 3.18 ± 0.83 (P = .087); and 2 months later, 4.08 ± 1.15 versus 3.38 ± 1.13 (P = .169). Brachial artery flows (mL/min) of the 2 groups at various time points were given as follows: immediately postoperation, 413.49 ± 145.09 versus 235.61 ± 87.77 (P < .001); 1 week later, 563.26 ± 206.83 versus 331.30 ± 126.78 (P < .001); 1 month later, 679.34 ± 218.56 versus 376.79 ± 156.25 (P < .001); and 2 months later, 736.31 ± 202.61 versus 394.60 ± 161.96 (P < .001). The primary patency at 1 year for the experimental group was 61.9% compared to 11.1% for the control group (P = .045). Similarly, the secondary patency rates at 1 year were 90.5% for the experimental group and 55.6% for the control group (P = .030). The results showed that the functional primary patency rate within 1 year was 57.1% versus 16.7% (P = .032), and the functional secondary patency rate within 1 year was 85.7% versus 50.0% (P = .038).
CONCLUSION SUBSECTIONS
BD has obvious advantages over hydrostatic dilation for chronic renal failure patients with small veins in establishing arteriovenous fistula in terms of patency and blood flow.
背景
为了研究使用球囊扩张（BD）技术扩张小血管对动静脉内瘘通畅性、血流量和静脉直径（VD）的影响。
方法
本研究的受试者均为首次接受头静脉动静脉内瘘手术且术前未接受透析的慢性肾衰竭患者，且 VD<2mm。将接受 BD 治疗的患者作为研究对象，或分配至对照组接受静压扩张治疗。分析两组在通畅性、血流量和 VD 方面的差异。
结果
共纳入 22 例接受球囊扩张组和 20 例对照组患者。实验组和对照组患者在不同时间点的头静脉（mm）直径比较：术后即刻，2.89±0.42 比 1.99±0.28（P<0.001）；术后 1 周，3.16±0.59 比 2.66±0.60（P=0.022）；术后 1 个月，3.76±0.91 比 3.18±0.83（P=0.087）；术后 2 个月，4.08±1.15 比 3.38±1.13（P=0.169）。两组患者在不同时间点的肱动脉血流量（mL/min）如下：术后即刻，413.49±145.09 比 235.61±87.77（P<0.001）；术后 1 周，563.26±206.83 比 331.30±126.78（P<0.001）；术后 1 个月，679.34±218.56 比 376.79±156.25（P<0.001）；术后 2 个月，736.31±202.61 比 394.60±161.96（P<0.001）。实验组 1 年内的主要通畅率为 61.9%，而对照组为 11.1%（P=0.045）。同样，实验组 1 年内的次要通畅率为 90.5%，而对照组为 55.6%（P=0.030）。结果显示，1 年内的功能主要通畅率为 57.1%比 16.7%（P=0.032），1 年内的功能次要通畅率为 85.7%比 50.0%（P=0.038）。
结论
BD 与静压扩张相比，对小静脉的慢性肾衰竭患者建立动静脉内瘘在通畅性和血流量方面具有明显优势。
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