TITLE: An ultrasound-guided no incision banding method for the treatment of arteriovenous fistula high-flow in hemodialysis.

OBJECTIVE:High-flow vascular access is one of the serious complications in the maturation and subsequent use of arteriovenous fistula (AVF). We adopted a novel surgical approach named no incision limited ligation indwelling needle assisted- revision (NILLINR) to treat high-flow of the hemodialysis vascular access and ascertained the outcomes by regular follow-up visits.

METHODS:This is a retrospective study. 26 hemodialysis patients with symptomatic high-flow access (access flow > 1500 mL/min) were treated with the novel banding method without incision between June 2018 and October 2020. The flow of the brachial artery before and after the restriction was measured by experienced clinicians by using the duplex Doppler ultrasound (DUS). All 26 patients were followed up for up to 1 year. Meanwhile, the brachial artery flow was recorded at 6 months and 1 year after restriction.

RESULTS:Of all 26 patients included in this study, the mean access flow volume decreased from 2196.2 ± 416.9 mL/min (mean ± SD) to 679.2 ± 67.1 mL/min immediately after the operation. During the follow-up, the volume flow of the brachial artery was still within the restricted range at 6 months (mean ± SD, 720.2 ± 164.7 mL/min) and 1 year (mean ± SD, 713.9 ± 173.8 mL/min) after the operation. Meanwhile, the mean duration of the operation is 8.5 ± 3.3 min, and there is no bleeding or rupture.

CONCLUSION:This novel no-incision limited ligation indwelling needle-assisted revision is a safe, effective, and time-saving option to treat high-flow access.

目的：高流量血管通路是动静脉瘘(AVF)成熟和应用的严重并发症之一。我们采用了一种新的手术入路，即无切口有限结扎留置针辅助翻修术(NILLINR)来治疗血液透析血管通路的高流量，并通过定期随访确定了临床结局。

方法：采用回顾性研究方法。自2018年6月至2020年10月，对26例有症状性高流量通路(通路流量>1500ml/min)的血液透析患者采用新型无切开结扎法进行治疗。由经验丰富的临床医生使用双功多普勒超声(DUS)测量限制前后的肱动脉血流。对26例患者进行了长达1年的随访。同时，分别于术后6个月和1年记录肱动脉血流量。

结果：26例患者术后即刻平均流量由2196.2±416.9mL/min降至679.2±67.1mL/min。术后6个月(平均720.2±164.7ml/min)和1年(平均713.9±173.8ml/m in)，肱动脉血流量仍在限制范围内。平均手术时间：8.5±3.3分钟。无出血、破裂等并发症。

结论：这种新的非切开有限结扎留置针辅助翻修术是治疗高流量通路的一种安全、有效、省时的选择。

启发：相对于外科切开手术，这个方式的确是一种新的尝试。但这一技术对术者超声的要求比较高，还要充分考虑血管的解剖位置（血管大小、与周围神经的关系、血管深度等），如何埋线也是一种技巧。可能因为篇幅原因，文中并未针对这些细节进行详细阐述，需要读者发挥想象，脑补更多操作细节。