桡动脉-肘正中静脉交通支动静脉内瘘术初步疗效分析

Analysis with Radio-communicating Branch of Median Cubital Vein Arteriovenous Fistulas

目的:探讨桡动脉-肘正中静脉交通支动静脉内瘘术的可行性和疗效。方法:选取前臂多次动静脉内瘘失败或前臂血管条件差无法行桡动脉-头静脉动静脉内瘘术的患者共8例,经术前多普勒超声评估后,于肘关节以下通过桡动脉-肘正中静脉交通支(静脉)端(动脉)侧吻合建立动静脉内瘘。并对术前、术后6周、术后3月桡动脉及上臂头静脉行多普勒超声检查,评估血管内径、血流动力学参数变化及瘘管成熟情况。结果:8例患者术前评估血管条件均符合自体静脉动静脉内瘘手术标准,即刻手术成功率100%。术后6周和3个月,桡动脉内径(diameter of radial artery,RAD)、头静脉内径(di-ameter of forearm cephalic vein,CVD)、桡动脉收缩期峰值流速(peak systolic velocity,PSV)、头静脉平均流速(mean velocity ofcephalic vein,CVMV)、头静脉血流(blood flow,BF)均高于术前,且术后3个月高于术后6周。患者随访6～12个月平均8.6个月,术后4～6周开始血透,瘘管均满足血透流量要求,目前均仍在继续使用。结论:(1)桡动脉-肘正中静脉交通支(静脉)端(动脉)侧吻合动静脉内瘘术式是安全可行的,术后瘘管成熟良好。(2)术前常规多普勒超声评估血管条件可以提高桡动脉-肘正中静脉交通支动静脉内瘘术式的成功率。

Objective：To evaluate the feasibility and the result of the operation type of radio-communicating branch of median cubital vein arteriovenous fistulas.Methods：Eight patients they were inappropriate for radio-cephalic ateriovenous fistula because of many times failure of operations or the poor condition of the forearm vascellum.All the patients received the operation of radio-communicating branch of median cubital vein arteriovenous fistulas.To assess the change of diameter of vascellum,hemodynamics and the maturation,the examination of color Doppler ultrasound were performed pre-operatively,6weeks and 3 months post-operatively.The ultrasound parameters included diameter of radial artery（RAD）,diameter of forearm cephalic vein（CVD）,peak systolic velocity（PSV）,mean velocity of cephalic vein（CVMV）、blood flow（BF）.Results：All the eight patients accorded with the criterion of native ateriovenous fistula,the immediate success rate of operation was 100%.RAD and CVD,PSV,CVMV and BF were higher by statistic significantly,comparing 6 weeks and 3months post-operation.And those were higher after 3 months compared with those after 6 weeks.Followed for 6~12momths,mean 8.6months,the hemodialysis started after 4~6 months post-opratively,the flow rate was able to meet the requirement.Conclusion：（1）The operation type of radio-communicating branch of median cubital vein arteriovenous fistula is safe and practicable.（2）The assessment of color Doppler ultrasound could improve the success rate of this operation.