Objective

The objective of this study was to evaluate the outcome of a short interposition using a small-diameter prosthetic graft as a flow-limiting procedure to manage symptomatic high-flow arteriovenous fistula (AVF).

Methods

A retrospective review of medical records on a case series was conducted. From June 2004 to April 2017, there were 25 patients with clinical symptoms of high output cardiac failure and progressive dilation of aneurysmal fistula vein due to high-flow AVF (≥1.5 L/min) who underwent short interposition with a 5-mm prosthetic graft at Saitama Medical Center. The primary outcome was the relief of clinical symptoms; other outcome measures included technical success, surgical complications, patency of vascular access, and postoperative changes in local and systemic hemodynamics as assessed by Doppler ultrasound.

Results

Twenty-five patients underwent short interposition for cardiac indications (n = 16) and aneurysmal dilation (n = 9). The technical success rate was 100%. The clinical symptoms were relieved in 24 patients (96.0%). Mean reduction in access blood flow was 52.4%. Cumulative primary unassisted patency rates (± standard error) at 1 year, 2 years, and 3 years were 76.2% ± 9.3%, 70.4% ± 10.3%, and 58.1% ± 11.6%, respectively. Secondary patency rates (± standard error) at 1 year, 2 years, and 3 years were 81.8% ± 8.2%, 71.5% ± 9.9%, and 71.5% ± 9.9%, respectively. Complications included access occlusion due to late thrombosis (n = 5 [21.7%]) and graft infection (n = 1 [4.3%]) in the median follow-up period of 3.9 years.

Conclusions

Short interposition with a prosthetic graft is a simple, effective, and durable treatment option for end-stage renal disease patients with cardiac symptoms and progressive dilation of the fistula vein due to high-flow AVF, offering clinical symptom resolution while preserving the autologous behavior of the initial access.

中文翻译：

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短时插入小直径假体以减少高流量动静脉瘘的流量。

目的

这项研究的目的是评估使用小直径假体移植作为限制症状性高流量动静脉瘘（AVF）的限流程序的短暂介入治疗的结果。

方法

对病例系列的病历进行了回顾性审查。从2004年6月至2017年4月，有25例患者因高流量AVF（≥1.5L / min）而发生了高输出心力衰竭和动脉瘤瘘静脉渐进扩张的临床症状，并对其进行了短暂介入并植入了5毫米假体在Sa玉医疗中心 主要结果是缓解临床症状。其他结局指标包括技术成功率，手术并发症，血管通畅性以及术后多普勒超声评估的局部和全身血流动力学变化。

结果

25例患者因心脏适应症（n = 16）和动脉瘤扩张（n = 9）进行了短暂的介入治疗。技术成功率为100％。24例患者的临床症状得到缓解（96.0％）。通路血流量的平均减少为52.4％。1年，2年和3年时的累计原发自主通畅率（±标准误差）分别为76.2％±9.3％，70.4％±10.3％和58.1％±11.6％。1年，2年和3年的二次通畅率（±标准误差）分别为81.8％±8.2％，71.5％±9.9％和71.5％±9.9％。并发症包括中位随访时间为3.9年的晚期血栓形成（n = 5 [21.7％]）和移植物感染（n = 1 [4.3％]）导致的入路阻塞。

结论

对于高血流性AVF导致心脏症状和瘘管静脉渐进扩张的终末期肾病患者，短时间与假体移植物之间插入是一种简单，有效且持久的治疗选择，可在保持临床患者自体行为的同时解决临床症状初始访问。