功能性端侧吻合法动静脉内瘘成形术在血液透析中的应用

目的:探讨功能性端侧吻合法动静脉内瘘成形术在血液透析中的应用价值。方法:选择我院肾内科接受自体动静脉内瘘成形术治疗的慢性肾脏病(CKD)4~5期患者140例,随机分成两组,每组70例。两组均采用标准前臂头静脉-桡动脉内瘘,对照组采用传统的端侧吻合,观察组采用功能性端侧吻合,比较两组手术成功率、内瘘通畅率及并发症等临床指标。结果:观察组血管吻合时间、内瘘成熟时间分别为均明显短于对照组周,首次手术成功率及1年通畅率均明显高于对照组(P0.05);截止到术后随访1年,观察组早期血栓形成及总并发症发生率均明显低于对照组(P0.05)。结论:功能性端侧吻合法动静脉内瘘成形术具有手术用时短、成功率高、术后内瘘通畅率高、并发症少等优点。     

维持性血液透析患者透析通路相关缺血综合征发病率及相关因素

目的 调查维持性血液透析患者透析通路相关缺血综合征及窃血现象发病率,对缺血综合征发生的危险因素进行分析.方法 采用横断面研究,选取2012年1至3月在北京市海淀医院以头静脉-桡动脉端侧吻合自体动静脉内瘘为通路行维持性血液透析者71例,询问并检查患者是否存在内瘘侧肢端发凉、发绀等缺血症状;应用彩色多普勒超声观察动静脉内瘘吻合口桡动脉近心端、远心端是否存在反向血流,测量内瘘吻合口、桡动脉、肱动脉内径及血流量;记录入组患者性别、高血压、糖尿病、吸烟和动脉硬化等,对上述指标进行量化后行logistic回归分析.结果 透析通路相关缺血综合征发病率为19.7％（14/71）.彩色多普勒超声显示,桡动脉远端血流方向及频谱方向均为反向者42例（59.2％）.多元回归分析显示,内瘘口径大小、肱动脉血流量、女性、糖尿病、动脉硬化不是缺血综合征的危险因素（均P＞0.05）.结论 动静脉内瘘后,缺血综合征发生率不低,目前尚不能通过控制内瘘口径大小等方法预防其发生.     

两种桡动脉切口端侧吻合动静脉内瘘近端静脉流出道狭窄的研究

目的 比较采用桡动脉前壁正中切口与前侧壁切口建立端侧吻合动静脉内瘘近端瘘静脉狭窄发生率的差异,探讨端侧吻合动静脉内瘘的桡动脉切口位置.方法 前瞻性纳入桂林医学院附属医院肾内科2017年3月至2018年2月新建立自体端侧吻合动静脉内瘘的患者160例,随机分为桡动脉前壁正中切口组(正中切口组,80例)及桡动脉前侧壁切口组(...     

腕部桡动脉-头静脉内瘘不同术式临床应用分析

自体动静脉内瘘是血液透析的首选血管通路.其中腕部桡动脉-头静脉内瘘是目前临床常选用的动静脉内瘘手术,其手术方式多样化,分别有传统端侧吻合术、传统端端吻合术、传统侧侧吻合术及改良的端侧吻合术、改良的端端吻合术、改良的侧侧吻合术.本文通过对比分析腕部桡动脉-头静脉内瘘成形术不同术式,阐述各自优缺点,以期指导临床腕部桡动脉-...     

自体动静脉内瘘术前桡动脉病理变化与血液透析患者全因死亡的相关性

目的:探讨慢性肾脏病5期患者行自体动静脉内瘘术前桡动脉血管的病理变化与血液透析患者全因死亡的相关性。方法:选取2009年1月1日至2018年12月31日在本院确诊为慢性肾脏病5期行自体动静脉内瘘成形术的患者140例,收集人口学资料、临床资料及实验室检查结果。所有患者随访至2019年6月。根据行自体动静脉内瘘术前取的桡动...     

显微动静脉内瘘术64例分析

目的 探讨供血液透析使用的动静脉内瘘术的手术方式及显微血管吻合操作技术。方法 收集64例动静脉内瘘术，比较桡动脉-头静脉侧端吻合术和桡动脉-头静脉端端吻合术两种不同术式的内瘘血流量及血管合并症，分析吻合口不同口径对内瘘血流量的影响。结果 内瘘血流量每分钟200ml以上56例，出现内瘘血管合并症8例，因血流量不足再次手术6例。动静脉侧端吻合的内瘘质量比端端吻合好，当吻合口小于0．5cm时内瘘血管合并症增加。结论 桡动脉-头静脉侧端吻合术是动静脉内瘘术的首选术式，血管吻合口的大小以0．5cm为适宜，血管吻合应遵循显微血管缝合原则。     

鼻烟窝动静脉内瘘不同术式的应用体会

鼻烟窝动静脉内瘘不同术式的应用体会解放军第152中心医院肾内科林新伟、董慧丽来稿：选择接受血液透析的终末期肾功能衰竭,进行鼻烟窝动静脉内瘘手术97例,按不同术式分为,端侧吻合组及端端吻合组。结果：两组间在小于1年、     

基质金属蛋白酶-2联合彩色多普勒超声在评估自体动静脉内瘘血管成熟中的价值

目的:探讨基质金属蛋白酶-2水平与自体动静脉内瘘成熟度的相关性,寻找评估内瘘成熟的方法。方法:研究对象来自温州医科大学附属第二医院医院肾内科进行AVF手术的成年患者37例,术前及术后随访,采用酶联免疫吸附法(ELISA)测定基质金属蛋白酶-2(MMP-2),通过物理检查和超声测量的方法检测患者术后的腕部自体动静脉内瘘成熟度,测量肱动脉、桡动脉的内径和流量,头静脉不同位点的内径等参数。MMP-2水平与内瘘是否成熟进行相关性分析。结果:37例患者平均年龄(61. 35±10. 01)岁,32例(86. 49%)内瘘位于左侧肢体,5例(13. 51%)内瘘位于右侧。8例(21. 62%)患者内瘘成熟不良。随访12周后,根据内瘘成熟度结果分组,发现糖尿病病史,MMP-2水平在两组间比较差异有统计学意义(P <0. 05)。超声评估结果显示:两组患者的肱动脉内径、肱动脉血流量、桡动脉近心端内径、头静脉平均内径间的差异有统计学意义(均P <0. 05)。内瘘成熟与肱动脉内径、肱动脉血流量、桡动脉近心端内径、头静脉平均内径呈正相关(r=0. 396、0. 714、0. 584、0. 715,P=0. 015、0. 000、0. 000、0. 000);与MMP-2水平呈负相关(r=-0. 517,P=0. 001)。以内瘘是否成熟作为因变量进行单因素logistic回归分析显示:肱动脉血流量(OR=27. 649,P=0. 000)、桡动脉近心端内径(OR=1. 611,P=0. 000)及MMP-2值水平(OR=0. 588,P=0. 000)是影响内瘘成熟的独立因素。结论:AVF术后患者MMP-2水平与自体动静脉内瘘成熟度之间具有相关性,MMP-2水平是影响内瘘成熟的独立因素。     

提高动静脉内瘘美观性的手术方法

临床资料 1．一般资料：选择2010年12月至2011年12月采用动静脉内瘘行血液透析患者65例,男35例,女30例,年龄25～65岁。术前常规检查均符合自体动静脉内瘘手术指征;均为首次行前臂桡动脉、头静脉内瘘成形术;均为端侧吻合,术后1个月即开始内瘘穿刺透析。     

301例自体动静脉内瘘吻合口径与动静脉内瘘通畅率的关系探讨

目的总结探讨进行长期维持性血透的终末期肾病患者自体动静脉内瘘吻合口径与动静脉内瘘通畅率的关系。方法分析自2012年4月至2014年3月桂林医学院第一附属医院收治的301例为行长期维持性血液透析而行手术创建动静脉内瘘的终末期肾病患者的资料,记录分析不同吻合口径患者内瘘成功率、术后通畅率、术后并发症等情况。结果 301例行自体动静脉内瘘血管转流术的患者,其中吻合口径5 mm 82例,吻合口径6 mm 81例,吻合口径7 mm 81例,吻合口径8 mm 57例,术后一期吻合成功率达100%,不同吻合口组术后通畅率:术后1个月,5、6、7、8 mm吻合口径内瘘通畅率分别为93.90%、97.53%、97.53%、98.25%(P术后1个月 0. 05);术后半年,内瘘通畅率分别为85.37%、90.12%、90.12%、91.23%(P术后半年0.05);术后1年,内瘘通畅率分别为75.61%、86.42%、83.95%、85.96%(P术后1年0.05);术后2年,内瘘通畅率分别为62.20%、75.31%、77.77%、77.19%(P术后2年0.05);术后3年,内瘘通畅率分别为54.88%、61.73%、71.60%、85.96%(P术后3年0.05),术后并发症(1个月内):术后血栓形成9例,术后手部肿胀6例,术口切口渗血9例,肢端窃血综合征1例。结论 7～8 mm的吻合口径较适宜,恰当吻合口径选择是提高自体动静脉内瘘通畅率的关键。     

Arteriovenous fistula aneurysmorrhaphy is associated with improved patency and decreased vascular access abandonment

BackgroundUpper extremity hemodialysis arteriovenous fistulas (AVFs) can become aneurysmal over time due to repeated cannulation and/or outflow steno-occlusive disease. The optimal surgical management of aneurysmal AVFs (aneurysmorrhaphy vs interposition graft) has remained unclear.MethodsWe performed a retrospective review in which current procedural terminology codes were used to screen for patients who had undergone surgical treatment of aneurysmal AVFs between 2016 and 2021 at a single hospital system. The patients were included after a review of the operative reports. The cases were divided by surgical procedure (aneurysmorrhaphy vs interposition graft placement). The patients who had undergone primary AVF ligation or other types of repair were excluded. The primary outcomes were primary assisted and secondary patency, and the secondary outcome was dialysis access abandonment. Multivariable Cox proportional hazards regression was used to test the association between the type of AVF aneurysm repair and the primary and secondary outcomes.ResultsFrom 2016 to 2021, 6951 patients had undergone 16,190 dialysis access procedures. Of these procedures, 381 (2.4%) were related to surgical treatment of an aneurysmal AVF. We excluded 58 primary AVF ligation cases and 20 cases involving other types of repair, leaving 303 cases for analysis. These were divided into two groups: aneurysmorrhaphy (n = 123; 41%) and interposition graft (n = 180; 59%). No differences were found between the groups in male gender (68% vs 63%), hypertension (98% vs 98%), or central stenosis (14% vs 22%). The patients who had undergone aneurysmorrhaphy were younger (median age, 54 years vs 59 years); had had a lower rate of diabetes (41% vs 59%), coronary artery disease (41% vs 58%), and congestive heart failure (41% vs 55%); and were less likely to have undergone upper arm access (72% vs 92%). The median follow-up was 11.1 months (interquartile range, 3.6-25.2 months). No differences were found in the incidence of 30-day wound complications (1% vs 3%) or surgical site infections (4% vs 6%). On multivariable Cox regression, interposition graft placement was associated with the loss of primary assisted patency (adjusted hazard ratio [aHR], 2.42; 95% confidence interval [CI], 1.18-4.95), loss of secondary patency (aHR, 3.10; 95% CI, 1.21-7.94), and abandonment of dialysis access (aHR, 3.07; 95% CI, 1.61-5.87; P < .05 for all) at 2 years.ConclusionsAVF aneurysmorrhaphy was associated with improved primary assisted and secondary patency and decreased abandonment of dialysis access. We suggest using aneurysmorrhaphy when AVF aneurysms are indicated for repair. However, individual factors such as patient comorbidities, AVF anatomy, remaining dialysis access options, and patient preference should be considered when planning the surgical approach.     

Comparison of outcomes of arteriovenous grafts and fistulas at a single Veterans' Affairs medical center

BACKGROUND: Before 2003, almost all dialysis access procedures performed at the G.V. Montgomery Veterans' Affairs Medical Center were arteriovenous grafts. In mid-2003, it was decided to place fistulas in most patients. This study compared the patency rates and frequency of interventions to maintain function between the 2 procedures. METHODS: Patency rates for 64 grafts and 50 fistulas were computed using Kaplan-Meier life-tables and compared using the Cox-Mantel log- rank test. The frequency of interventions to maintain function was compared using a Poisson model. RESULTS: Primary patency of grafts at 1 and 2 years was 39% and 26%, and that of fistulas was 44% and 37%. Secondary patency of grafts at 1 and 2 years was 71% and 63%, and that of fistulas was 75% and 72%. Neither difference reached significance. The difference in interventions also was insignificant. CONCLUSIONS: Switching from grafts to fistulas did not significantly improve the patency and frequency of interventions.     

Comparative blood flow study of arteriovenous fistulae in canine femoral arteries: modified latero-lateral and end-lateral techniques

The aim of this study was to evaluate the blood flow of an arteriovenous fistula comparing the modified latero-lateral (LLM) and end-lateral (TL) techniques in canine femoral arteries. Ten mongrel dogs were submitted to 2 arteriovenous fistulae each, with a LLM on one side and a TL procedure on the other side. Cranial and caudal average blood flow as well as average venous flow were measured by an electronic fluxometer 15, 20, and 25 min after surgery. Mann-Whitney, Friedman, and Wilcoxon nonparametric tests were used for data analysis (alpha 相似文献   

Laparoscopic resection of Osler-Weber-Rendu lesion.

BACKGROUND AND OBJECTIVES: Osler-Weber-Rendu is a hereditary disease characterized by telangiectasias, arteriovenous malformations, and aneurysms involving the cutaneous, gastrointestinal, pulmonary, and central nervous systems. This report describes a combinatorial approach using laparoscopic and intraoperative endoscopy to perform a partial gastric resection of bleeding arteriovenous malformations. METHODS: A 70-year-old female with a history of bleeding from Osler-Weber-Rendu disease presented to the emergency department complaining of hematemesis. Her vital signs were unstable, and she was immediately resuscitated with intravenous fluids and transfusions. A combined laparoscopic and intraoperative endoscopic approach to a partial gastric resection was planned. Intraoperatively, a single lesion was identified along the posterior aspect of the greater curvature of the stomach by using endoscopy. The blood supply was taken down with a Ligasure and gastric resection with a 60-mm Echelon stapler. RESULTS: The pathology report confirmed the complete resection of the arteriovenous malformations. The patient recovered well and was discharged home several days later without any pain complaints. CONCLUSIONS: Little has been written about the medical treatment of Osler-Weber-Rendu arteriovenous malformations, let alone surgical treatment. A combinatorial laparoscopic and intraoperative endoscopic approach to gastric resection allows both minimization of the gastric resection and the complete identification and removal of the arteriovenous malformations.     

血液透析患者动静脉内瘘成功的影响因素

目的　了解影响动静脉内瘘成功的因素。方法　 40例新建内瘘病例术中测动静脉管径、动脉血流量、吻合口口径、内瘘血流量及术前平均动脉压。其中 ,18例还进行多普勒超声检查 ,测量术前动静脉管径、动脉血流量及术后连续 6周随访内瘘血流量和管径。结果　通过单因素、多因素回归分析 ,平均动脉压、动脉血流量与术后短时间的内瘘血流量呈正相关 (P <0 0 5 ) ;静脉管径与术后内瘘血流量呈正相关 (P <0 0 5 )。术后随访期内瘘血流量和管径随时间逐渐增加 (P <0 0 5 )。结论　低血压、静脉管径细会造成内瘘失败 ,术前动脉血流量达到 2 0ml/min术后可很快获得满意的血流量 ;吻合口口径在 8～ 10mm较为适宜 ;内瘘的使用尽量在 6周以后。     

前臂非常规自体动静脉瘘在血液透析患者中的应用及护理

目的：探讨前臂非常规自体动静脉瘘在维持性血液透析患者中的临床应用和护理方法。方法2007年12月至2013年12月对119例维持性透析患者进行前臂非常规自体动静脉瘘手术,其中,81例为原桡动脉-头静脉内瘘失功,38例为初次行血管内瘘手术。所有患者均有针对性地采用系统化护理干预。结果在119例患者中,109例患者手术一次取得成功（92％）,术后血流量200～350 ml/min。对患者的心功能未造成不良影响,未出现严重并发症。结论有针对性的系统化护理干预能够有效提高前臂非常规自体动静脉手术的成功、成熟和使用。     

Management of pancreatic arteriovenous malformation

Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage. Received: January 27, 2000 / Accepted: April 6, 2000     

Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners

Recent data indicate that the incidence of end-stage renal disease (ESRD) in pediatric patients (age 0–19 years) has increased over the past two decades. Similarly, the prevalence of ESRD has increased threefold over the same period. Hemodialysis (HD) continues to be the most frequently utilized modality for renal replacement therapy in incident pediatric ESRD patients. The number of children on HD exceeded the sum total of those on peritoneal dialysis and those undergoing pre-emptive renal transplantation. Choosing the best vascular access option for pediatric HD patients remains challenging. Despite a national initiative for fistula first in the adult hemodialysis population, the pediatric nephrology community in the United States of America utilizes central venous catheters as the primary dialysis access for most patients. Vascular access management requires proper advance planning to assure that the best permanent access is placed, seamless communication involving a multidisciplinary team of nephrologists, nurses, surgeons, and interventional radiologists, and ongoing monitoring to ensure a long life of use. It is imperative that practitioners have a long-term vision to decrease morbidity in this unique patient population. This article reviews the various types of pediatric vascular accesses used worldwide and the benefits and disadvantages of these various forms of access.