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

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. 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. 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. This novel no-incision limited ligation indwelling needle-assisted revision is a safe, effective, and time-saving option to treat high-flow access.高流量血管通路异常是动静脉瘘（arteriovenous fistula, AVF）成熟及后续临床使用过程中常见的严重并发症之一。本研究采用一种命名为无切口有限结扎留置针辅助修复术（no incision limited ligation indwelling needle assisted- revision, NILLINR）的新型手术方案，治疗血液透析血管通路高流量病症，并通过定期随访评估其临床疗效。本研究为回顾性研究。2018年6月至2020年10月期间，共计26例伴症状性高流量血管通路（通路血流量＞1500 mL/min）的血液透析患者接受了该新型无切口环扎术治疗。由经验丰富的临床医师采用彩色多普勒超声（duplex Doppler ultrasound, DUS）检测血流限制术前后的肱动脉血流量。全部26例患者均完成了长达1年的随访，并分别于术后6个月、1年记录肱动脉血流量。本研究纳入的26例患者中，术后即刻平均通路血流量由术前的2196.2±416.9 mL/min（均值±标准差）降至679.2±67.1 mL/min。随访期间，术后6个月（均值±标准差：720.2±164.7 mL/min）及术后1年（均值±标准差：713.9±173.8 mL/min）的肱动脉血流量仍维持在受限范围内。此外，该术式的平均手术时长为8.5±3.3 min，未出现出血、破裂等不良事件。这种新型无切口有限结扎留置针辅助修复术是治疗血液透析高流量血管通路的安全、有效且省时的临床可选方案。