Silva M B, Hobson R W, Pappas P J, Haser P B, Araki C T, Goldberg M C, Jamil Z, Padberg F T
Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2714, USA.
J Vasc Surg. 1997 Dec;26(6):981-6; discussion 987-8. doi: 10.1016/s0741-5214(97)70010-7.
We describe a technique of superficial venous transposition in the forearm used for the formation of an arteriovenous fistula for hemodialysis access. These modifications of the single-incision radiocephalic fistula are designed to increase options for arteriovenous fistulas by using veins and arteries that are suitable for use but are not in immediate proximity.
Arteries and veins suitable for a primary arteriovenous fistula were identified and mapped using duplex ultrasound in 89 patients. Separate incisions were used in the majority of cases, and the selected forearm vein was mobilized, angiodilated, and transposed into a subcutaneous tunnel on the volar aspect of the forearm. Before initiation of hemodialysis, duplex ultrasound scanning was performed, and the location that was most suitable for cannulation was identified. Repeat scans were performed at 3-month intervals for analysis of patency.
Superficial venous transpositions were performed using a single incision in 13 instances in which the vein was in immediate proximity to the radial artery (type A). Dorsal-to-volar forearm transposition (type B) was performed in 30 veins with anastomoses to the radial (n = 26), ulnar (n = 2), or brachial (n = 2) arteries. Volar-to-volar forearm transposition (type C) was performed in the remaining 46 veins, with anastomoses to the radial (n = 42), ulnar (n = 2), or brachial arteries (n = 2). Successful hemodialysis was accomplished in 81 of 89 patients (91%). The primary cumulative patency rate was 84% at 1 year and 69% at 2 years. The mean duration of follow-up was 14.3 months.
The use of superficial venous transposition for the formation of autogenous hemoaccess was associated with ease of cannulation by dialysis personnel, high maturation rates, reduced early failure rates, and enhanced patency rates. We recommended the use of these technical modifications to increase the use of autogenous fistulas in the forearm.
我们描述一种在前臂进行浅静脉转位的技术，用于形成动静脉内瘘以建立血液透析通路。对单切口桡动脉-头静脉内瘘进行这些改良，旨在通过使用合适但并非紧邻的动静脉来增加动静脉内瘘的选择。
通过双功超声对89例患者适合一期动静脉内瘘的动静脉进行识别和标记。大多数病例采用单独切口，将选定的前臂静脉游离、血管扩张后转位至前臂掌侧的皮下隧道。在开始血液透析前，进行双功超声扫描，确定最适合穿刺的部位。每隔3个月进行重复扫描以分析通畅情况。
13例静脉紧邻桡动脉的情况（A型）采用单切口进行浅静脉转位。30条静脉进行了从背侧到掌侧的前臂转位（B型），分别与桡动脉（n = 26）、尺动脉（n = 2）或肱动脉（n = 2）吻合。其余46条静脉进行了掌侧到掌侧的前臂转位（C型），分别与桡动脉（n = 42）、尺动脉（n = 2）或肱动脉（n = 2）吻合。89例患者中有81例（91%）成功进行了血液透析。1年时的初始累积通畅率为84%，2年时为69%。平均随访时间为14.3个月。
使用浅静脉转位形成自体血液通路便于透析人员穿刺，成熟率高，早期失败率降低，通畅率提高。我们建议采用这些技术改良以增加前臂自体动静脉内瘘的使用。
