关键词: 血液透析, 动静脉内瘘, 输尿管导管, 介入

Abstract: Objective To evaluate the use of ureteral catheter during arteriovenous fistula (AVF) surgery. Methods A retrospective analysis was performed on 78 cases (43 females, 35 males, 16～79 years of age, mean age 48.2±13.5 years) of uremic patients who underwent AVF in Chongqing Southwest Hospital from Jan. 2013 to Jan. 2016. Their dialysis age was 0～120 months (average 30.3±11.8 months). Primary AVF surgery was performed in 47 cases, and AVF reconstruction in 31 cases. Color Doppler ultrasonography was used before AVF surgery. Patients with thin forearm vein or suspicious of segment stenosis were confirmed to have vein diameter ＞1.5 mm and segmental stenosis diameter＞1 mm in the surgical area. Patients with normal arterial pulse were confirmed to have artery diameter ＞1.5mm and flow rate ＞20 cm/s. During the AVF surgery, two models of ureteral catheter (F5 with diameter of 1.5mm or F6 with diameter of 1.9mm) were used according to the diameter of the vein to explore the arteries and veins before arteriovenous anastomosis. If blockage occurred after arteriovenous anastomosis during the operation, ureteral catheter was then used again to explore the arteries. Results For all the 78 cases, ureteral catheter was used to explore the vein and to expand the beam before arteriovenous anastomosis. After the expansion, 56 cases (71.8%) showed no obvious proximal stenosis and the AVFs were successful constructed; 20 cases (25.6%) still exhibited proximal vein stenosis. In patients with forearm vein stenosis, a second incision was performed at the proximal of the narrow segment, and then anastomose successfully. In patients with stenosis in upper arm vein, the narrow segment was excised and an end-to-end anastomosis of the original vein or the autogenous vein graft was then built. Three cases with vascular blockage after anastomosis were explored using the ureteral catheter. After the thrombus in artery or anastomotic site taken out from the exploratory rip, the continuity of the fistula was rebuilt. Two cases (2.6%) with recurrent artery or vein thrombosis were unable to dredge the internal fistula, and the operation was finially given up. The overall intraoperative patency rate was 97.4%, and AVF can be used normally in 71 (91%) cases during the follow-up for 6 months. Conclusion During AVF surgery, intraoperative exploration before arteriovenous anastomosis with ureteral catheter can obtain the shape of blood vessels, display obvious stenosis sites, and expand the blood vessels properly. Furthermore, exploration with ureteral catheter after anastomosis has the unique advantage of interventional treatment when the blood vessels are blocked by the fresh small thrombi in arteries. AVF surgery program decision through preoperative careful physical examination, vascular ultrasonography and intraoperative exploration with ureteral catheter can improve the success rate of AVF and save limited vascular resources. The low cost and minimal risk of vascular exploration using ureteral catheter make this method worth to be used clinically.

Key words: Hemodialysis, Arteriovenous fistula, Ureteral catheter, Intervention.