Abstract: Objective To observe the effect of vein superficializing surgery on the promotion of autologous arteriovenous fistula maturation. Methods Eleven end-stage renal disease patients who had an autologous arteriovenous fistula surgery 1-3 month ago with a distance of > 6mm between the anterior wall of the internal fistula vein and skin by ultrasound were selected for vein superficializing surgery. After the surgery, the possible complications including bleeding, hematoma and infection were monitored. After the surgery for 4 weeks, the distance between anterior wall of the internal fistula vein and skin, diameter of the internal fistula vein, natural blood flow rate, and puncturable length were measured by color ultrasound, and compared with those before the surgery. After use of the internal fistula for blood access for 2 weeks, dialysis adequacy Kt/V was evaluated. Results None of the patients had bleeding, hematoma and infection due to the surgery, and 3 of them had temporal arm edema which disappeared after 2 weeks. After the surgery for one month, the distances between anterior wall of the internal fistula vein and skin reduced from 6.2～12.5mm (average 8.87±2.00mm) before the surgery to 0.8～1.8mm (average 1.28±0.33mm; t=13.616, P=0.000); the diameters of the internal fistula vein increased from 4.4～6.8mm (average 5.55±0.67mm) before the surgery to 4.8～7.5mm(average 5.77±0.76mm; t=2.915, P=0.015); the natural blood flow rate increased from 681.55±167.93 ml/min before the surgery to 781.00±170.34 ml/min (t= 4.105, P=0.002); the puncturable length was 9～14cm (average 10.91±1.45cm); and the average dialysis adequacy of Kt/V was 1.59±0.24. By Feb. 2017, no thrombosis occurred in the 11 patients, and the internal fistulas were satisfactorily used for blood access 3 times a week with a longest normal usage period of 13 months. Conclusions Superficializing surgery of internal arteriovenous fistula provides a possibility for hemodialysis patients to effectively use autologous arteriovenous fistulas. This is a simple, safe and effective method without requirements of specific instruments and devices.

Key words: arteriovenous fistula, Superficializing surgery, hematodialysis, chronic renal failure, two-stage surgery