Jin Zhuan, Sugiyama Daisuke, Matsunami Masatoshi, Kuji Hiroshi, Yoshinuma Hiromi, Suzuki Tomo, Morimatsu Hiroshi, Ueda Kenichi
Department of Anesthesiology, Kameda Medical Center, Kamogawa, Japan.
Department of Anesthesiology and Resuscitology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
Clin Exp Nephrol. 2025 Jul 1. doi: 10.1007/s10157-025-02722-8.
Achieving functional arteriovenous fistulas (AVFs) with sustained patency in chronic kidney disease (CKD) patients remains challenging. Preoperative vessel diameter and early postoperative blood flow are key determinants of AVF maturation. While regional anesthesia promotes vasodilation, it carries procedural risks and requires specialized expertise. Stellate ganglion light irradiation (SG-LI) using near-infrared light (NIR) is a minimally invasive alternative for vasodilation. We evaluated the safety, feasibility, and vasodilatory effects of SG-LI for AVF creation in CKD patients.
This pilot study was prospectively registered (jRCT1032230550) and enrolled adult CKD patients scheduled for elective AVF creation at Kameda Medical Center in Japan between January and March 2024. SG-LI was performed preoperatively using a near-infrared therapy device. Ultrasound measured vessel diameters before and after SG-LI. The primary outcome was the diameter change in cephalic vein. Secondary outcomes included diameter changes in the median cubital vein, communicating vein, radial artery, and brachial artery. Adverse events and AVF patency at one and six months were also assessed.
SG-LI significantly increased vessel diameters in the cephalic vein (0.29 ± 0.23 mm, p = 0.034), median cubital vein (1.06 ± 0.80 mm, p = 0.002), and brachial artery (0.22 ± 0.27 mm, p = 0.034). No significant changes were observed in the radial artery (0.09 ± 0.16 mm, p = 0.108) or communicating vein ( - 0.014 ± 0.45 mm, p = 0.613). No adverse events occurred. AVF patency was 100% at one and six months.
SG-LI is a safe, feasible, and minimally invasive modality that induces vasodilation in CKD patients. It may offer an alternative to regional anesthesia for AVF creation.
This study was prospectively registered on Japan Registry of Clinical Trials (jRCT1032230550).
在慢性肾脏病（CKD）患者中实现具有持续通畅性的功能性动静脉内瘘（AVF）仍然具有挑战性。术前血管直径和术后早期血流量是AVF成熟的关键决定因素。虽然区域麻醉可促进血管舒张，但它存在操作风险且需要专业技能。使用近红外光（NIR）的星状神经节光照射（SG-LI）是一种用于血管舒张的微创替代方法。我们评估了SG-LI在CKD患者中创建AVF的安全性、可行性和血管舒张效果。
这项前瞻性注册的试点研究（jRCT1032230550）纳入了2024年1月至3月期间在日本龟田医疗中心计划择期创建AVF的成年CKD患者。术前使用近红外治疗设备进行SG-LI。超声测量SG-LI前后的血管直径。主要结局是头静脉直径的变化。次要结局包括肘正中静脉、交通静脉、桡动脉和肱动脉直径的变化。还评估了不良事件以及1个月和6个月时AVF的通畅情况。
SG-LI显著增加了头静脉（0.29±0.23mm，p = 0.034）、肘正中静脉（1.06±0.80mm，p = 0.002）和肱动脉（0.22±0.27mm，p = 0.034）的直径。桡动脉（0.09±0.16mm，p = 0.108）或交通静脉（-0.014±0.45mm，p = 0.613）未观察到显著变化。未发生不良事件。1个月和6个月时AVF通畅率均为100%。
SG-LI是一种安全、可行且微创的方法，可在CKD患者中诱导血管舒张。它可能为创建AVF提供一种替代区域麻醉的方法。
本研究已在日本临床试验注册中心（jRCT1032230550）进行前瞻性注册。
