Sign In
A subscription to JoVE is required to view this content. Sign in or start your free trial.
We present a modified no-touch technique (MNTT) to create a radio-cephalic arteriovenous fistula (RC-AVF) in which the venous and arterial wall avoid devascularization and the radial artery does not sever.
Autologous arteriovenous fistula (AVF) is the primary and best option to obtain vascular access for hemodialysis treatment; other options are arteriovenous graft (AVG) and central venous catheterization (CVC). The implementation of radio-cephalic autologous arteriovenous fistula (RC-AVF) in the forearm was preferred among patients with superior vascular conditions. However, there is a high rate of early fistula failure. The chosen surgical method is understood to have an effect on the maturation of the fistula. New surgical procedures such as radial artery deviation and reimplantation (RADAR) have been significantly improved for juxta-anastomotic stenosis. Nevertheless, new problems such as stenosis of arteries and narrowing of surgical indication were also found. In this report, we presented a modified no-touch technique (MNTT) to create an RC-AVF, in which the venous and arterial wall avoid devascularization and the radial artery does not sever.
Radio-cephalic autologous arteriovenous fistula (RC-AVF) have been regarded as the primary and best choice for vascular access in hemodialysis patients1,2. However, the early failure to mature continues to be a major problem with RC-AVF creation3. Different surgical methods have different degrees of vascular injury and affect the maturation of RC-AVF. In 1996, Souza4 first proposed the use of a no-touch technique (NTT) to separate the great saphenous vein in coronary artery bypass grafting and achieved good results5
The MNTT was conducted according to the human research protocol approved by the ethics committee of the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University (IRB2021029).
1. Preoperative evaluation
Since January 2021, we have applied the MNTT technique in 10 patients to construct AVF. Seven of the 10 patients have been under dialysis.
None of the patients had fever or infection after surgery. Physical examination of the cephalic-vein at weeks 4 and 8 showed significant dilation. Fistula can be palpable tremor with loud murmur. Doppler ultrasonography showed obvious dilation of the cephalic vein and radial artery. The blood flow spectrum of the cephalic vein 1.5 cm away from the anastomos.......
Venous juxta-anastomotic stenosis is one of the main factors affecting the maturation of AVF5. It is known to be closely related to intimal hyperplasia13,14,15. However, prevention strategies for intimal hyperplasia are still limited. Modified surgical procedures16 such as RADAR have been shown to have less venous juxta-anastomotic stenosis, increased maturation and patency, and fe.......
We thank doctors Zhou Feng, Ma Tiantian, and Zhu Dongming at our hospital for providing the assistance with ultrasound examination.
....Name | Company | Catalog Number | Comments |
Curved hemostatic forceps | Xinhua Surgical Instrument Co., Ltd. | ZH131R/RN | |
Dissecting Forceps | Xinhua Surgical Instrument Co., Ltd. | ZDO25R/RN | |
Electrotome | Changzhou Yanling Electronic Equipment Co., Ltd. | TY21205812 | |
Eyelld Retractor | Xinhua Surgical Instrument Co., Ltd. | Z014602T | |
Lidocaine | Hebei Tiancheng Pharmaceutical Co., Ltd. | 1B200612104 | |
Halsey needleholder | Xinhua Surgical Instrument Co., Ltd. | ZM208R/RN | |
Micro forceops | Xinhua Surgical Instrument Co., Ltd. | ZD275RN/T | |
Micro needle holder forceps | Xinhua Surgical Instrument Co., Ltd. | ZF2618RB/T | |
Micro scissors | Xinhua Surgical Instrument Co., Ltd. | ZF022T | |
Micro vessel knife | Xinhua Surgical Instrument Co., Ltd. | ZF1549RN | |
Non-absorbable suture 3-0 | Ethicon,LLC | SA84G | |
Poly propylene 7-0 | Ethicon,LLC | PDB601 | |
Sharp blade | Suzhou Medical Products Factory Co., Ltd. | TY21232001 | |
scalpel handle | Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instruments Factory | J11030 | |
Syringe with needle (5ml) | BD medical devices (Shanghai) Co., Ltd | 2006116 | |
Triangle needle | Hangzhou Huawei medical supplies Co., Ltd | 7X17 | |
Vessel clamp | Xinhua Surgical Instrument Co., Ltd. | ZF220RN | |
Vessel loop | Shenzhen Yiman Technology Co., Ltd | EM-SR1 |
This article has been published
Video Coming Soon
ABOUT JoVE
Copyright © 2025 MyJoVE Corporation. All rights reserved
We use cookies to enhance your experience on our website.
By continuing to use our website or clicking “Continue”, you are agreeing to accept our cookies.