肘部动静脉内瘘手术解剖学基础及临床应用
Anatomy and clinical significance of elbow arteriovenous fistulas
目的 探讨肘部动静脉内瘘的手术方法及在血液透析中的应用。 方法 2006年5月至 2012年5月完成肘部动静脉内瘘术22例。采用肘关节横纹下2～3 cm横切口，其中桡动脉与肘正中静脉端侧吻合17例，侧侧吻合2例，2例采用头静脉与肱动脉进行侧侧吻合，1例采用贵要静脉与肱动脉进行侧侧吻合。所有患者围手术期均采用彩色多普勒进行动态观察评估。 结果 平均手术时间为(120±16.15) min。在手术中无外科并发症。术后内瘘均立即通畅，前臂可触及动脉搏动。平均内瘘成熟时间为(41±8.15) d。术后早期1例因动脉搏动欠佳出现血栓阻塞。2例出现短暂性前臂局部水肿。其余患者未出现盗血综合征，动脉瘤，栓塞，感染，出血等并发症。 结论 肘部动静脉内瘘是维持血液透析患者一个理想和安全的选择。手术方法应根据患者肘部血管的解剖学特点进行选择。
Objective To investigate the use of vascular access in maintenance hemodialysis and the complications of elbow arteriovenous fistulas (AVF). Methods From our database of consecutive vascular access operations, we reviewed 22 patients from May 2006 to May 2012 for all elbow arteriovenous fistulas. A transverse skin incision was made 2-3cm below the elbow crease. Radial artery and brachial artery were used as the in-flow conduit in 19 patitens and 3 patients respectively. The median cubital vein was anastomosed to the radial artery in end-to-side fashion in 17 cases and side-to-side fashion in 2 cases, the cephalic vein and the basilic vein were anastomosed to the brachial artery in side-to-side fashion in 2 cases and 1 case respectively. All patients were evaluated with preoperative ultrasound imaging by the operating surgeon. Results Mean operative time was 120±16.15min. There were no major intraoperative complications. Immediate patency and a palpable distal radial pulse were presented in all the patients. Mean time to fistula maturation was 41±8.15 days. Early fistula failure was seen in one patient because of thrombosis. Early transient arm edema were seen in two patients. No patient developed a vascular steal syndrome, pseudoaneurysm, infection and bleeding during the perioperative time. Conclusions An elbow AVF is a reasonable and safe alternative for maintenance hemodialysis access when a radiocephalic AVF is not possible. There are various valid options from which to choose to best accommodate each patient's antecubital anatomy.
[1] Wish JB. Vascular access for dialysis in the United States: progress, hurdles, controversies, and the future
[J]. Semin Dial, 2010, 23(6):614-618.
[2] Stoli R, Jovanovi A, Trajkovi G, et al. Problem of creation of arteriovenous fistulae for hemodialysis in older patients
[J]. Med Pregl, 2010,63（5-6）:313-317.
[3] National kidney Foundation:KDOQI Clinical Practice guidelines and clinical practice recommendations for vascular acess
[J]. Am J Kidney Dis, 2006,48(Suppl 1):S176-S322.
[4] Bender MH, Bruyninckx CM, Gerlag PG. The brachiocephalic elbow fistula:a useful alternative angioaccess for permanent hemodialysis
[J]. J Vasc Surg, 1994, 20(5):808-813.
[5] Dukkipati R, de Virgilio C, Reynolds T, et al. Outcomes of brachial artery-basilic vein fistula
[J].Semin Dial, 2011, 24(2):220-230.
[6] Dagher FJ, Gelber RL, Ramos EJ, et al. Basilic vein to brachial artery fistula:a new access for chronic hemodialysis
[J].South Med J, 1976, 69(11):1438-1440.
[7] Tan TW, Farber A. Brachial-basilic autogenous access
[J]. Semin Vasc Surg, 2011,24(2):63-71.
[8] Salahi H, Fazelzadeh A, Mehdizadeh A, et al. Complications of arteriovenous fistula in dialysis patients
[J].Transplant Proc, 2006, 38(5):1261-1264.
[9] 钟伟强，杨铁诚，刘冠贤，等. 血液透析动静脉内瘘显微吻合不同口径的影响
[J].中华显微外科杂志，1999，22（2）：154-155.
[10] Ferring M, Henderson J, Wilmink A, et al. Vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemoidalysis:review of the evidence
[J]. Nephrol Dial Transplant, 2008, 23(6):1809-1815.
[11]Huber TS, Ozaki CK, Flynn TC, et al. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access
[J].J Vasc Surg, 2002, 36(3):452-459.
[12]Karakayali FY, Sevmis S, Basaran C, et al. Relationship of preoperative venous and arterial imaging findings to outcome of brachiobasilic transposition fistulae for hemodialysis:a prospective clinical study
[J]. Eur J Vasc Endovasc Surg, 2008,35(2):208-213.
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