肘部动静脉内瘘手术解剖学基础及临床应用

Abstract

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

CLC Number:

R658.3

LAI Pan-Hua, TUN Ji-Hua, SUN Xiu-Yong. Anatomy and clinical significance of elbow arteriovenous fistulas[J]. Chinese Journal Of Clinical Anatomy, 2012, 30(6): 701-704.

References

[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.

[1]	Chen Ren, Yang Shengbo. Research progress on the anatomy and clinical application of masseter muscle [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 115-117.
[2]	Chen Zhuhong, Li Yanbing, Huang Huajun, Lin Xijiang, Zeng Canjun. Anatomical study of posterior pelvic ring injury combined with contralateral anterior pelvic ring injury treated with modified pararectus abdominis incision [J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 633-639.
[3]	Wu Wenbin, Hu Yutian, Dai Linxi, Lv Wangxuan, Lv Fengjun, Yin Yuanjie, Yang Hongmeng, Chang Junda, Li Wenqi, Guo Yiwei. Applied anatomical study of anesthesia in vertebral ganglia [J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 640-646.
[4]	Bai Jiyue, Xu Yongqing. Anatomical research of selective peripheral neurotomy in the treatment of cerebral palsy [J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 754-756.
[5]	Nie Zheng, Jiang Heng, Chen Mengmeng, Shan Jianlin. Anatomical relationship between the accessory nerve and the cervical fascia and its clinical significance [J]. Chinese Journal of Clinical Anatomy, 2023, 41(4): 382-384.
[6]	Song Hao, Yang Mengyuan, Lu Yiwen, Zhang Xudong, Chen Ruixue. CBCT study on the anatomical factors related to anterior dental implants [J]. Chinese Journal of Clinical Anatomy, 2023, 41(4): 401-408.
[7]	Ding Ran, Zheng Xuefeng, Ding Zihai, Wu Tao. Clinical anatomy study of cholecystic vein and distribution of its branches [J]. Chinese Journal of Clinical Anatomy, 2023, 41(3): 249-253.
[8]	Wang Dechang, Gong Zheyi, Liao Chenghao, Zhi Shasha, Zou Xufei, Hu Yaohui, Wang Kai, Lou Yangyun, Li Ting . Microdissection of the atrioventricular conduction axis of fresh porcine heart [J]. Chinese Journal of Clinical Anatomy, 2023, 41(3): 254-257.
[9]	Wu Shiyuan, He Haoqiang, Chen Zhenghe, Mou Yonggao, Li Yanbing, Huang Wenhua, Zhong Shizhen. Three-dimensional reconstruction of superior petrosal vein by multi-modal fusion technology [J]. Chinese Journal of Clinical Anatomy, 2023, 41(3): 270-276.
[10]	Li Mingzhe, Wang Tao, Cong Peijie, Wang Chengtao, Liu Xiaoliu. The specimen preparation for a modular brain complex [J]. Chinese Journal of Clinical Anatomy, 2023, 41(3): 365-366.
[11]	He Xiaoqing, Yang Xi, Shi Yan, Xu Yuexian, Fang Xiang, Fan Xinyu, Wu Yaling, Xu Yongqing. Anatomical study and clinical significance of superficial lateral sural artery perforator flap [J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 132-136.
[12]	Zhao Zhiheng, Wu Yue, Zhang Jing, Yang Zitao, Zhang Qinyong, Wang Qingwei, Cheng Jingliang , Che Yingyu. Comparative study of anatomical structure and functional characteristics of pelvic floor in normal young men and women by static and dynamic magnetic resonance imaging [J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 143-149.
[13]	Zhou Ruiling, Li Ying, Huang Diqing, Zhao Zengjiang, Ding Hui, Zhang Hui, Chen Wei. Study on clinical application of 256-slice spiral CT in 3D reconstruction of anatomical relationship between the right hepatic portal vein and hepatic vein [J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 150-155.
[14]	Zhou Chunhui, Lv Wenying, Dong Chao, Zhang Jianning, Sun Junzhao. Application of multimodal electromagnetic navigation in endoscopic endonasal approach of fresh cadavers [J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 156-161.
[15]	Mei Yixuan, Liu Hailan, Liu Cheng, Zhang Yi, Liu Shuwei. Multi-slice spiral CT study on anatomical variations of pulmonary veins [J]. Chinese Journal of Clinical Anatomy, 2023, 41(1): 8-14.

Anatomy and clinical significance of elbow arteriovenous fistulas

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0