Name: creating radio-cephalic arteriovenous fistula in the forearm with a modified no-touch technique
Uploaded: 2022-04-01T12:30:00
Description: Watch this Scientific Journal Video about Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique at JoVE.com

我们感谢我院的周峰、马天田、朱东明医生为超声检查提供帮助。

MNTT是根据南京医科大学附属苏州科技镇医院伦理委员会（IRB2021029）批准的人类研究方案进行的。
1. 术前评估
<ol><li>检查病史：确保患者无凝血异常、瓣膜性心脏病、充血性心力衰竭、外周血管疾病、皮肤病、中心静脉导管插入史、起搏器植入史、颈部和胸部外伤或手术疾病。</li>
	<li>进行体格检查结果：确保上肢血压对称，动脉脉搏良好，脉动强，Allen <sup clas...

<ol>
	<li>Trerotola, S. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=KDOQI+clinical+practice+guideline+for+vascular+access+2019+update:+Kinder,+Gentler,+and+More+Important+Than+Ever.">KDOQI clinical practice guideline for vascular access 2019 update: Kinder, Gentler, and More Important Than Ever.</a> Journal of Vascular and Interventional Radiology. 31 (7), 1156-1157 (2020).</li><li>Schmidli, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Editor's+Choice+-+vascular+access:+2018+clinical+practice+guidelines+of+the+European+Society+for+Vascular+Surgery+(ESVS).">Editor's Choice - vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS).</a> European Journal of Vascular and Endovascular Surgery. 55 (6), 757-818 (2018).</li><li>Abreo, K., Buffington, M., Sachdeva, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Angioplasty+to+promote+arteriovenous+fistula+maturation+and+maintenance.">Angioplasty to promote arteriovenous fistula maturation and maintenance.</a> Journal of Vascular Access. 19 (4), 337-340 (2018).</li><li>Souza, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+no-touch+preparation+technique:+Technical+notes.">A new no-touch preparation technique: Technical notes.</a> Scandinavian Journal of Thoracic and Cardiovascular Surgery. 30 (1), 41-44 (1996).</li><li>Souza, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High+early+patency+of+saphenous+vein+graft+for+coronary+artery+bypass+harvested+with+surrounding+tissue.">High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue.</a> Annals of Thoracic Surgery. 71 (3), 797-800 (2001).</li><li>Souza, D. S., Gomes, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+future+of+saphenous+vein+graft+for+coronary+artery.">The future of saphenous vein graft for coronary artery.</a> Revista Brasileira de Cirurgia Cardiovascular. 23 (3), (2008).</li><li>Souza, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Harvesting+the+saphenous+vein+with+surrounding+tissue+for+CABG+provides+long-term+graft+patency+comparable+to+the+left+internal+thoracic+artery:+results+of+a+randomized+longitudinal+trial.">Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial.</a> Journal of Thoracic and Cardiovascular Surgery. 132 (2), 373-378 (2006).</li><li>H&#246;rer, T. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=No-touch+technique+for+radiocephalic+arteriovenous+fistula:+surgical+technique+and+preliminary+results.">No-touch technique for radiocephalic arteriovenous fistula: surgical technique and preliminary results.</a> Journal of Vascular Access. 17 (1), 6-12 (2016).</li><li>Sadaghianloo, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radial+artery+deviation+and+reimplantation+inhibits+venous+juxta-anastomotic+stenosis+and+increases+primary+patency+of+radial-cephalic+fistulas+for+hemodialysis.">Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis.</a> Journal of Vascular Surgery. 64 (3), 698-706 (2016).</li><li>Xiaohe, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+no-touch+technique+for+anastomosis+to+create+a+radiocephalic+arteriovenous+fistula.">A modified no-touch technique for anastomosis to create a radiocephalic arteriovenous fistula.</a> Journal of Vascular Surgery Cases, Innovations and Techniques. 7 (4), 686-690 (2021).</li><li>Lok, C. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=KDOQI+Clinical+Practice+Guideline+for+Vascular+Access:+2019+Update.">KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update.</a> American Journal of Kidney Diseases. 75 (4), 1 (2020).</li><li>Xiaohe, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+report+of+4+cases+of+autogenous+forearm+arteriovenous+fistula+constructed+by+modified+no-touch+technique.">Clinical report of 4 cases of autogenous forearm arteriovenous fistula constructed by modified no-touch technique.</a> Chinese Journal of Blood Purification. 10 (20), 693-695 (2021).</li><li>Allon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+of+preexisting+arterial+intimal+hyperplasia+with+arteriovenous+fistula+outcomes.">Association of preexisting arterial intimal hyperplasia with arteriovenous fistula outcomes.</a> Clinical Journal of the American Society of Nephrology. 13 (9), 1358-1363 (2018).</li><li>Allon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vascular+calcification,+intimal+hyperplasia,+and+arteriovenous+fistula+maturation.">Vascular calcification, intimal hyperplasia, and arteriovenous fistula maturation.</a> American Journal of Kidney Diseases. 58 (3), 437-443 (2011).</li><li>Vazquez-Padron, R. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=intimal+hyperplasia+and+arteriovenous+fistula+failure:+looking+beyond+size+differences.">intimal hyperplasia and arteriovenous fistula failure: looking beyond size differences.</a> Kidney360. 2 (8), 1360-1372 (2021).</li><li>Shenoy, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+technique+determines+the+outcome+of+the+Brescia/Cimino+AVF.">Surgical technique determines the outcome of the Brescia/Cimino AVF.</a> Journal of Vascular Access. 18, 1-4 (2017).</li><li>Bai, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Artery+to+vein+configuration+of+arteriovenous+fistula+improves+hemodynamics+to+increase+maturation+and+patency.">Artery to vein configuration of arteriovenous fistula improves hemodynamics to increase maturation and patency.</a> Science Translational Medicine. 12 (557), (2020).</li></ol>

静脉并列吻合口狭窄是影响AVF5成熟的主要因素之一。已知它与内膜增生密切相关13，14，15。然而，内膜增生的预防策略仍然有限。经修改的外科手术16 （如 RADAR）已被证明具有较少的静脉并列吻合口狭窄，成熟度和通畅性增加，以及较少的二次干预9，<sup class="xref"...

放射性头颅自体动静脉瘘 （RC-AVF） 被认为是血液透析患者血管通路的主要和最佳选择1，2。然而，早期未能成熟仍然是RC-AVF创建的主要问题3。不同的手术方法有不同程度的血管损伤，影响RC-AVF的成熟。1996年，Souza4首次提出使用无接触技术（NTT）分离冠状动脉旁路移植术中的大隐静脉，并取得了良好的效果5，6，7。Horer等人是第一个使用NTT构建RC-AVF的人。在1年的随访中，原发性通畅率为54%，继发通畅率为80%。Sadaghianloo等人进一步扩展了无接触技术的概念，提出了桡动脉偏斜和再植入（RADAR）技术。这种技术与较少的并列吻合口狭窄有关。然而，流入动脉狭窄在雷达上更为突出。我们推测这可能与桡动脉的切断和动脉远端的骨架化有关。
为了进一步减少手术过程中对静脉和动脉的伤害，我们提出了一种新的改良无接触技术（MNTT），该技术显着提高了通畅率和瘘管成熟度10。该技术的目的是主要避免静脉和动脉壁的血运脱以及桡动脉的切断。切开皮肤和皮下组织后，在浅筋膜下方看到头静脉及其周围的脂肪组织。在浅筋膜和头静脉壁上做一个8-10毫米长的切口，将桡动脉椎弓根（包括桡动脉及其伴随的静脉）隔离40-50毫米。动脉椎弓根未被切断，桡动脉椎弓根抬高至接近头静脉。在动脉中做了一个8-10毫米长的切口。侧对侧进行吻合术，并连接远端静脉以形成功能性的端到端吻合术（图1）。
10例手术前通过多普勒超声对血管进行评估：桡动脉和头静脉无狭窄，桡动脉直径≥1.6 mm，头静脉直径≥2 mm。超声心动图显示左心室评分>60%，患者无手术禁忌证。动脉和静脉之间<2 cm的距离被确定为拟议的吻合部位。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/62784/62784fig01.jpg"> 图 1.AVF中吻合类型的示意图12. a：AVF的常规手术。 b：使用 NTT 创建的 AVF。 c：使用MNTT和功能性端到端吻合器创建的AVF。AVF：动静脉瘘;NTT：无接触技术。 <a href="https://www.jove.com/files/ftp_upload/62784/62784fig01large.jpg" target="_blank">请点击此处查看此图的放大版本。</a>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Curved hemostatic forceps</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZH131R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Dissecting Forceps</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZDO25R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Electrotome</td>
			<td>Changzhou Yanling Electronic Equipment Co., Ltd.</td>
			<td>TY21205812</td>
			<td></td>
		</tr>
		<tr>
			<td>Eyelld Retractor</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>Z014602T</td>
			<td></td>
		</tr>
		<tr>
			<td>Lidocaine</td>
			<td>Hebei Tiancheng Pharmaceutical Co., Ltd.</td>
			<td>1B200612104</td>
			<td></td>
		</tr>
		<tr>
			<td>Halsey needleholder</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZM208R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro forceops</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZD275RN/T</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro needle holder forceps</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF2618RB/T</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro scissors</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF022T</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro vessel knife</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF1549RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Non-absorbable suture 3-0</td>
			<td>Ethicon,LLC</td>
			<td>SA84G</td>
			<td></td>
		</tr>
		<tr>
			<td>Poly propylene 7-0</td>
			<td>Ethicon,LLC</td>
			<td>PDB601</td>
			<td></td>
		</tr>
		<tr>
			<td>Sharp blade</td>
			<td>Suzhou Medical Products Factory Co., Ltd.</td>
			<td>TY21232001</td>
			<td></td>
		</tr>
		<tr>
			<td>scalpel handle</td>
			<td>Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instruments Factory</td>
			<td>J11030</td>
			<td></td>
		</tr>
		<tr>
			<td>Syringe with needle (5ml)</td>
			<td>BD medical devices (Shanghai) Co., Ltd</td>
			<td>2006116</td>
			<td></td>
		</tr>
		<tr>
			<td>Triangle needle</td>
			<td>Hangzhou Huawei medical supplies Co., Ltd</td>
			<td>7X17</td>
			<td></td>
		</tr>
		<tr>
			<td>Vessel clamp</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF220RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Vessel loop</td>
			<td>Shenzhen Yiman Technology Co., Ltd</td>
			<td>EM-SR1</td>
			<td></td>
		</tr>
	</tbody>
</table>

creating radio-cephalic arteriovenous fistula in the forearm with a modified no-touch technique

自体动静脉瘘（AVF）是获得血液透析治疗血管通路的主要和最佳选择。其他选择包括动静脉移植物 （AVG） 和中心静脉导管插入术 （CVC）。在前臂实施放射头颅自体动静脉瘘（RC-AVF）是血管状况较好的患者的首选。然而，早期瘘管衰竭的发生率很高。所选择的手术方法被认为对瘘管的成熟有影响。对于并列吻合口狭窄，新的外科手术（如桡动脉偏移和再植入 （RADAR））已得到显著改善。然而，还发现了新的问题，如动脉狭窄和手术适应症变窄。在本报告中，我们提出了一种改进的无接触技术（MNTT）来创建RC-AVF，其中静脉和动脉壁避免血运脱，桡动脉不会切断。

自2021年1月以来，我们已经在10名患者中应用了MNTT技术来构建AVF。10名患者中有7名接受过透析。
手术后没有患者发烧或感染。第4周和第8周的头静脉体格检查显示明显扩张。瘘管可伴有响亮杂音的可触及震颤。多普勒超声检查显示头静脉和桡动脉明显扩张。距吻合口1.5cm的头静脉血流谱显示螺旋层流（图3）。MNTT构建的瘘管可以用两根针反复穿刺。肱动脉...

Watch this Scientific Journal Video about Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique at JoVE.com

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique

我们提出了一种改进的无接触技术（MNTT）来创建放射性头动静脉瘘（RC-AVF），其中静脉和动脉壁避免血运脱，桡动脉不会切断。

使用改进的非接触技术在前臂中创建放射性头动静脉瘘

Autologous arteriovenous fistula (AVF) is the primary and best option to obtain vascular access for hemodialysis treatment; other options are ...

使用改进的非接触技术在前臂中产生放射性头动静脉瘘。在根治性动脉靠近前臂头静脉的地方创建了一个四厘米的皮肤切口。浅筋膜暴露后，可以看到筋膜上下方的头静脉。在接触根治性动脉脉搏的位置逐层切口。动脉鞘暴露。血管钳用于阻断血流。使用7.0不可吸收的单丝连续缝合线创建静脉到动脉的侧向吻合术。最后，连接头颅远端静脉以形成功能性的端到端吻合口。在视频中，我们介绍了一种改进的无接触技术，在这种技术中，我们保持了血管周围血管组织的完整。在手术过程中，脂肪和静脉周围的结缔组织保持了完整性，完全避免了对头静脉的损伤。从2021年1月开始，我们招募了连续10名患者，通过修改无接触技术来构建AVF。八至20周的后续工作现已完成。检查病史。执行体格检查结果。确保两肢血压对称，动脉脉搏良好，脉动强劲，艾伦试验阴性，前臂和上臂连续头静脉，结合止血带后静脉扩张良好，上肢无水肿或静脉曲张，既往无中枢或外周静脉瘢痕。通过彩色多普勒超声对患者手术肢体的前臂脉管系统进行全面评估。将患者置于仰卧位，外旋并外展手术上肢，然后常规进行消毒悬垂和局部浸润麻醉，含1%利多卡因。在前臂根治动脉和头静脉之间小于两厘米的距离处做一个四厘米的纵向切口。使用弯曲的止血钳分离皮下脂肪组织以暴露浅表筋膜。可以看到浅筋膜下方的头静脉及其周围组织。在此步骤中不应打开浅表筋膜，也不应使用电刀止血。沿垂直于头静脉的方向形成两条隧道。隧道开口应位于距头静脉两侧一厘米以上的地方。逐层切割组织，露出根治性动脉椎弓根，包括根治性动脉及其伴随静脉，位于根治性动脉的假位区域，可以用食指到达。将小动脉分支固定，并用止血钳挑出根治性动脉梗，将根治性动脉弓根解剖约40至50毫米。将两个红色血管环穿过根治性动脉梗的两端。根治性动脉可以被拉近头静脉，以促进手术缝合。在椎弓根两端放置一个血管夹以阻塞动脉血流。虽然血管钳用于阻断血流，但完整的组织保留在头静脉周围，对血管起更好的保护作用。用麦克风pro镊子轻轻抬起头静脉的浅表筋膜，并用微型剪刀或锋利的刀切开浅表筋膜和头静脉壁。切口长度应约为8至10毫米，依次打开动脉鞘和根治性动脉壁，用锋利的刀和微小的剪刀做8至10毫米长的切口，注意不要扭曲血管。使用7.0不可吸收的单强度缝合线建立静脉动脉吻合口，并排与冷却技术缝合血管后壁，然后缝合血管前壁。血管应彼此靠近，以减少血管张力。打开血流，像它一样与远端头静脉一样形成功能性内细胞吻合术，并使用床垫缝合线进行手术切口。第4周和第8周的头静脉体格检查显示明显扩张，瘘管可明显震颤，伴有响亮的杂音。多普勒超声检查显示头静脉和根治性动脉的乙酰化。距吻合口 1.5 厘米的头静脉血流谱显示翼状层流。该表显示，距吻合口5厘米处的头静脉血流量超过每分钟500毫米。肱动脉的肱动脉每分钟超过600毫米。成功完成4小时血液透析。目前没有任何患者有任何血管通路相关并发症。RC-AVF构建的改进无接触技术和功能性端到端吻合是可行的，短期结果令人鼓舞，但需要大量患者来彻底评估该技术。

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Medicine

Modified Technique for Coronary Artery Ligation in Mice

改性技术在小鼠冠状动脉结扎

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI ...

科研

医学

Technical Aspects of the Mouse Aortocaval Fistula

在的鼠标Aortocaval瘘的技术方面

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

Human Skeletal Muscle Biopsy Procedures Using the Modified Bergstr&#246;m Technique

Human Skeletal Muscle Biopsy Procedures Using the Modified BergstrÃƒÆ’Ã‚Â¶m Technique

人骨骼肌活检手术使用修改伯格斯坦技术

The percutaneous biopsy technique enables researchers and clinicians to collect skeletal muscle tissue samples. The technique is safe and highly ...

A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail

动静脉内瘘失败的新型小鼠模型：在详细介绍手术过程

The arteriovenous fistula (AVF) still suffers from a high number of failures caused by insufficient remodeling and intimal hyperplasia from which the ...

Intraluminal Drug Delivery to the Mouse Arteriovenous Fistula Endothelium

腔内药物输送到鼠标动静脉瘘内皮

Delivery of therapeutic agents to enhance arteriovenous fistula (AVF) maturation can be administered either via intraluminal or external routes. The ...

Mouse Model for Pancreas Transplantation Using a Modified Cuff Technique

应用改良袖套技术的小鼠胰腺移植模型

Mouse models have several advantages in transplantation research, including easy handling, a variety of genetically well-defined strains, and the ...

Modified Technique for the Use of Neonatal Murine Hearts in the Langendorff Preparation

新生儿鼠心在朗根多夫制剂中的应用改良技术

The use of the ex-vivo retrograde perfused heart has long been a cornerstone of ischemia-reperfusion investigation since its development by Oskar ...

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

腹腔镜胰十二指肠切除术使用原 位 非接触式隔离技术治疗胰腺癌

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

胸腰椎后凸畸形患者改良后椎柱切除术

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

A Modified Technique for Arteriovenous Fistula Construction in Rabbits

一种改良的兔动静脉瘘构建技术

Juxta-anastomotic stenosis is a challenging problem that often causes non-maturation and decreases the patency of an arteriovenous fistula (AVF). Injury ...