关键词: 动静脉内瘘, 血液透析, 解剖

Abstract:

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.

Key words: Arteriovenous fistulas, Hemodialysis, Anatomy