TITILE: The Pre-dilatation of vessels: A simple method to recruit small caliber veins for creating distal fistulas

Abstract:
Maturation failure remains a major clinical problem of distal arteriovenous fistula (AVF). Early failure (EF) is associated with the small size of the veins. For about 10 years we have used in more than 1000 fistulas, the Vessels Pre-Dilatation (VPD) to increase the recruitment of small veins for creating distal AVFs. The purpose of this study is to highlight if the VPD can reduce the incidence of EF or failure to mature (FTM) in AVFs created with small veins. Data of all the consecutive patients directly admitted to our Department for their first distal AVF from January to December 2019 were collected. The patients were divided in two groups, one with a vein diameter after the tourniquet ⩽2.0 mm (G1) and one >2 mm (G2). Both in G1 then in G2 the vessels had undergone VPD. Immediate failure (IF), EF, FTM, delayed or arrested maturation rate (DAM), unassisted AVFs and matured AFVs were evaluated. The patients recruited totalled 104, 37 in G1, and 67 in G2. The two groups were homogeneous in age, incidence of diabetes, obesity, heart disease, peripheral vasculopathy, and race. Female were more numerous in G1 (51% vs 12%, p < 0.001). In G1 and G2 occurred respectively 3 IF versus zero (p < 0.05), 10 EF (29%) versus 6 (9%) (p < 0.05), 6 DAM (16%) versus 6 (9%), 21 unassisted AVFs (57%) versus 57 (85%) (p < 0.01). Dividing the patients into groups of unassisted and assisted AVFs, female and low vein diameter are more represented in the assisted group. There were 32 matured AVFs (86%) in G1 and 65 (97%) in G2. In order to increase the incidence of the distal AVF, the PDV allows to include small veins. However, more patients require further interventions to achieve maturation of the fistula.

Source:lNapoli M, Zito A, Lefons ML, et al. The Pre-dilatation of vessels: A simple method to recruit small caliber veins for creating distal fistulas[J]. J Vasc Access, 2021 :1129729820983170. DOI: 10.1177/1129729820983170.

摘要：远端动静脉内瘘(AVF)的主要临床问题是成熟不良。早期通路衰竭(EF)与静脉较小有关。大约10年来，我们已经在1000多个瘘管中使用了血管预扩张(VPD)，以预扩血管（VPD）的方式增加小静脉的入组。本研究的目的是强调VPD是否能降低小静脉动静脉瘘的EF或未成熟(FTM)的发生率。收集我科2019年1月至12月连续收治的首次远端动静脉动静脉瘘患者的资料。将患者分为两组，一组在⩽止血带后静脉内径>2 mm(G1组)，另一组>2 mm(G2组)。G1组和G2组的血管均经历了VPD。评价即刻失效(IF)、早期失功（EF）、成熟障碍（FTM）、延迟或停滞成熟率(DAM)、非辅助性AVF和成熟AFV。招募的患者总数为104人，其中G1组37人，G2组67人。两组在年龄、糖尿病、肥胖、心脏病、外周血管病变和种族方面的发病率相同。G1组女性较多(51%vs12%，p<0.001)。G1组和G2组分别为3例IF和0例(P<0.05)，10例EF(29%)和6例(9%)(P<0.05)，6例DAM(16%)和6例(9%)，21例无辅助AVF(57%)和57例(85%)(P<0.01)。将患者分为非辅助组和辅助组，辅助组女性和静脉内径较小。G1组成熟动静脉瘘32例(86%)，G2组65例(97%)。为了增加远端动静脉瘘的发生率，PDV允许包括小静脉。然而，更多的患者需要进一步的干预来实现瘘管的成熟。

启发：不可忽视小静脉的可扩张性，强大的代偿功能是内瘘的补偿机制，经常突破我们的想象。扩张性和非扩张性存在极大的差异，可扩张性代表一定的内瘘潜力，这是不容忽视的。