Short interposition with a small-diameter prosthetic graft for flow reduction of a high-flow arteriovenous fistula
Short interposition with a small-diameter prosthetic graft for flow reduction of a high-flow arteriovenous fistula
复制标题
使用小直径假体移植物进行短距离介入，以减少高流量动静脉瘘的流量
DOI：
10.1016/j.jvs.2020.05.035
复制
发表时间：
2021
影响因子：
4.3
通讯作者：
Deguchi Juno
中科院分区：
文献类型：
--
作者：
Hashimoto Takuya;Akagi Daisuke;Yamamoto Satoshi;Suhara Masamitsu;Sato Osamu;Deguchi Juno
本研究的目的是评估一个短的插入使用一个小直径的假体移植物作为一个流量限制程序，以管理症状性高流量动静脉瘘（AVF）的结果methodsA回顾性审查的病例系列的医疗记录进行。从2004年6月至2017年4月，有25例患者因高流量AVF（≥1.5 L/min）而出现高输出量心力衰竭和囊肿瘘静脉进行性扩张的临床症状，在琦玉医疗中心接受了5 mm人工移植物的短期插入。主要结果是临床症状的缓解;其他结局指标包括技术成功，手术并发症，血管通路通畅，局部和全身血流动力学的术后变化评估多普勒ultrason.Results25例进行短期介入心脏适应症（n = 16）和动脉瘤扩张（n = 9）。技术成功率为100%。24例（96.0%）临床症状缓解。入路血流量平均减少52.4%。1年、2年和3年时的累积一期无辅助通畅率（±标准误）分别为76.2% ± 9.3%、70.4% ± 10.3%和58.1% ± 11.6%。1年、2年和3年时的二期通畅率（±标准误）分别为81.8% ± 8.2%、71.5% ± 9.9%和71.5% ± 9.9%。并发症包括由于晚期血栓形成导致的通路闭塞（n = 5 [21.7%]）和移植物感染（n = 1 [4.3%]），中位随访期为3.9年。结论：对于因高流量AVF而出现心脏症状和瘘静脉进行性扩张的终末期肾病患者，提供临床症状解决，同时保留初始通路的自体行为。
ObjectiveThe objective of this study was to evaluate the outcome of a short interposition using a small-diameter prosthetic graft as a flow-limiting procedure to manage symptomatic high-flow arteriovenous fistula (AVF).MethodsA retrospective review of medical records on a case series was conducted. From June 2004 to April 2017, there were 25 patients with clinical symptoms of high output cardiac failure and progressive dilation of aneurysmal fistula vein due to high-flow AVF (≥1.5 L/min) who underwent short interposition with a 5-mm prosthetic graft at Saitama Medical Center. The primary outcome was the relief of clinical symptoms; other outcome measures included technical success, surgical complications, patency of vascular access, and postoperative changes in local and systemic hemodynamics as assessed by Doppler ultrasound.ResultsTwenty-five patients underwent short interposition for cardiac indications (n = 16) and aneurysmal dilation (n = 9). The technical success rate was 100%. The clinical symptoms were relieved in 24 patients (96.0%). Mean reduction in access blood flow was 52.4%. Cumulative primary unassisted patency rates (± standard error) at 1 year, 2 years, and 3 years were 76.2% ± 9.3%, 70.4% ± 10.3%, and 58.1% ± 11.6%, respectively. Secondary patency rates (± standard error) at 1 year, 2 years, and 3 years were 81.8% ± 8.2%, 71.5% ± 9.9%, and 71.5% ± 9.9%, respectively. Complications included access occlusion due to late thrombosis (n = 5 [21.7%]) and graft infection (n = 1 [4.3%]) in the median follow-up period of 3.9 years.ConclusionsShort interposition with a prosthetic graft is a simple, effective, and durable treatment option for end-stage renal disease patients with cardiac symptoms and progressive dilation of the fistula vein due to high-flow AVF, offering clinical symptom resolution while preserving the autologous behavior of the initial access.