背景:慢性肾脏病(CKD)影响全球13%的人口,并且由于ESRD而需要肾脏替代疗法。血液透析(HD)是ESRD患者最常见的透析方式,但由于高发病率和死亡率,建立血管通路具有挑战性.动静脉瘘(AVF)是血管通路的黄金标准,但许多失败是由于吻合血流动力学,静脉直径,和吻合缝合技术。进行了一项前瞻性研究,以评估两种连续缝合技术的影响,锚技术和降落伞技术,关于AVF的初始结果。
方法:这是随机的,对照研究包括在我们中心进行AVF创建的成年患者。我们将患者分为两组:锚和降落伞。四名熟练的血管通路外科医生执行了该程序。主要目标是AVF的功能成熟,定义为准备插管的AVF瘘,插管静脉长度至少为10厘米,直径大于6毫米,深度小于6毫米,和600mL/min的流速。次要目标包括通畅性和并发症,如出血,感染,偷窃综合征,吻合部位的动脉瘤扩张。术后和门诊随访期间立即评估AVF。进行双重扫描以测量不同间隔的流量。所有患者均提供适当的书面同意书。
结果:该研究涉及186名患者,86被排除在外。100人被随机分组,5例失去随访,3例在12个月内死亡。随访持续到2024年1月,平均为8.6个月。与Anchor相比,降落伞技术显示出更高的技术成功(p值=0.046)和30天的主要通畅性(p值=0.014)。但是两组在6周时的功能成熟没有统计学意义(p值=0.352)。降落伞技术的血肿率高于锚杆技术(p值=0.025),而其他并发症如术中出血,术后出血,假性动脉瘤形成,血栓形成,偷窃综合征,和血清瘤形成没有显着差异。9名患者,其中五人是糖尿病患者,接受了保守的治疗,表现为轻度至中度盗血综合征。这表明糖尿病患者中盗血综合征的风险增加。
结论:用于AVF创作的降落伞技术提供了更好的技术成功和短期的主要通畅性结果,而降落伞和锚定技术对于长期功能成熟和总体并发症发生率同样有效。
BACKGROUND: Chronic kidney disease (CKD) affects 13% of the global population and requires renal replacement therapy due to ESRD. Hemodialysis (HD) is the most common dialysis modality for ESRD patients, but establishing vascular access is challenging due to high morbidity and mortality rates. Arteriovenous fistulas (AVFs) are the gold standard for vascular access, but many fail due to anastomotic hemodynamics, vein diameter, and anastomatic suture technique. A prospective study was conducted to evaluate the impact of two continuous suturing techniques, the anchor technique and the parachute technique, on AVFs\' initial outcomes.
METHODS: This randomized, controlled study involved adult patients who presented for AVF creation at our center. We divided the patients into two groups: anchors and parachutes. Four skilled vascular access surgeons performed the procedures. The primary goal was functional maturation of the AVF, defined as an AVF fistula ready to be cannulated with a cannulating vein length of at least 10 cm, a diameter of more than 6 mm, a depth of less than 6 mm, and a flow rate of 600 mL/min. Secondary goals included patency and complications such as bleeding, infection, steal syndrome, and aneurysmal dilatation at the anastomosis site. AVFs were evaluated immediately after surgery and during follow-up visits at the outpatient clinic. A duplex scan was performed to measure flow at various intervals. All patients provided appropriate written consent.
RESULTS: The study involved 186 patients, with 86 excluded. 100 were randomized, with 5 cases losing follow-up and 3 deaths within 12 months. The follow-up continued until January 2024, with a mean of 8.6 months. The Parachute technique shows higher technical success (p value = 0.046) and primary patency at 30 days (p value = 0.014) compared to Anchor, but there is no statistical significance between both groups regarding functional maturation at 6 weeks (p value = 0.352). The parachute technique has a higher hematoma rate than the anchor technique (p value = 0.025), while other complications like intra-operative bleeding, postoperative bleeding, pseudoaneurysm formation, thrombosis, steal syndrome, and seroma formation show no significant differences. Nine patients, five of whom were diabetic and underwent conservative management, exhibited mild to moderate steal syndrome. This suggests an increased risk of steal syndrome among diabetic patients.
CONCLUSIONS: The parachute technique for AVF creation offers better technical success and short-term primary patency outcomes, while both parachute and anchor techniques are equally effective for long-term functional maturation and overall complication rates.