Analysis of options for mitigating hemodialysis access-related ischemic steal phenomena
Analysis of options for mitigating hemodialysis access-related ischemic steal phenomena
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DOI：
10.1007/s10016-003-0103-1
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发表时间：
2004-01-01
影响因子：
1.5
通讯作者：
Pozrikidis, C
中科院分区：
文献类型：
--
作者：
Gradman, WS;Pozrikidis, C
与血液透析通路的肱动脉桥移植物相关的盗血现象可能会损害前臂的血流。这项工作的目的是调查和比较，通过一个简单的数学模型，潜在的六个外科手术，以减轻盗窃。开发了基于电模拟的流动模型。一个非锥形的6毫米假肢臂腋通道（PBAA）被选为原型配置，和六个入口修改前臂流量的理论效果进行了分析。主要的简化包括使用Poiffuille定律来估计动脉阻力，而忽略侧支循环的贡献。术中流量测量使用跨音速流量计获得两个人正在接受治疗的盗血综合征。血流模型预测，远端血运重建-间隔结扎（DRIL）手术实现了远端血流的最大增加，随后是6 mm腋肱动脉旁路移植术（无间隔结扎）、PBAA转换为腋-腋环通路以及转换为腋-肱通路。两名患者的术中测量结果与理论计算结果密切相关。简单的流程模型提供了一个易于处理的框架，用于比较旨在避免或处理窃取现象的程序。在选定的临床环境中，远端血运重建（无间隔结扎）和PBAA转换为腋-腋袢入路或腋肱入路可以有效替代DRIL手术。
Steal phenomena associated with brachial bridge grafts for hemodialysis access may compromise blood flow to the forearm. This work is designed to investigate and compare, by means of a simple mathematical model, the potential of six surgical procedures to alleviate steal. A flow model based on an electrical analogue was developed. An untapered 6-mm prosthetic brachial-axillary access (PBAA) was selected as the prototype configuration, and the theoretical effect of six access modifications on forearm flow was analyzed. Major simplifications include the use of Poiseuille's law for estimating arterial resistance and ignoring the contribution of collateral circulation. Intra-operative flow measurements using a Transonic flowmeter were obtained in two individuals undergoing treatment for a steal syndrome. The flow model predicts that the greatest increase in distal flow is achieved by the distal revascularization-interval ligation (DRIL) procedure, followed by a 6-mm axillobrachial artery bypass graft without interval ligation, the conversion of the PBAA to an axillary-axillary loop access, and the conversion to an axillary-brachial access. Intra-operative measurements in two patients agreed closely with theoretical calculations. A simple flow model provides a tractable framework for comparing procedures designed to avoid or treat steal phenomena. Distal revascularization without interval ligation and the conversion of a PBAA to an axillary-axillary loop access or an axillary brachial access can be effective alternatives to the DRIL procedure in selected clinical settings.