Multi-center management of arteriovenous fistulas for hemodialysis with a single venous outflow tract in the antecubital perforating vein

doi:10.3969/j.issn.1004-583X.2026.03.006

Abstract

Abstract:

Objective To retrospectively analyze the clinical diagnosis and treatment of surgically treated dysfunctional arteriovenous fistulas (AVFs) for a single vein outflow tract in the antecubital perforating vein (APV), and to explore the surgical management strategies for such AVFs. Methods Clinical data, treatment modalities, and follow-up outcomes of hemodialysis patients diagnosed with dysfunctional AVFs for a single vein outflow tract in the APV and required for surgical interventions in the Nephrology Department of three medical institutions from August 2019 to August 2025 were retrospectively reviewed. Success rate, complications, and primary/secondary patency rates were analyzed. Results A total of 27 patients were included, with a mean age of 64.55±11.58 years. The AVF had been established for 50.00 (17.00, 124.00) months. A total of 29 surgeries were performed, including interposition of artificial blood vessel, transposition and anastomosis of the basilic vein(BV), anastomosis of the transvenous BV, AVF reconstruction, and/or combined percutaneous transluminal angioplasty (PTA). AVF function was restored in 26 patients, with a technical success rate of 89.66%, and three failed operations were performed in PTA group. The median follow-up duration was 21.00 (11.75, 27.50) months, and the overall patency rate was 84.61%. The primary patency rate at 6, 12, 18, and 24 months was 88.50%, 69.80%, 41.90%, and 41.90%, respectively. During the follow-up period, 57.69% (15/26) of patients experienced recurrent AVF failures, which was restored by PTA. The 2-year secondary patency rate was 100%. The probability of repeat surgical intervention for AVF in the artificial blood vessel group was higher than that in the other groups. Conclusion Surgical reconstruction of the AVF outflow tract is an effective treatment for dysfunctional AVFs for a single vein outflow tract in the APV, with a high surgical success rate. However, the probability of long-term recurrent AVF failure is high, especially after an interposition of the artificial blood vessel. PTA can be used as an adjunct to achieve good long-term patency.

Key words: arteriovenous fistula, single venous outflow tract through vein, dysfunction, outflow tract reconstruction, patency rate

CLC Number:

R654.4

Cheng Huidong, Lou Wenyuan, Liu Tongqiang, Li Jing, Mao Wenbin, Mou Hongbin, He Jianqiang. Multi-center management of arteriovenous fistulas for hemodialysis with a single venous outflow tract in the antecubital perforating vein[J]. Clinical Focus, 2026, 41(3): 228-234.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.03.006

https://www.lchc.cn/EN/Y2026/V41/I3/228

Figures/Tables 7

References 22

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项目	数值
年龄(岁)	64.55±11.58
男[例(%)]	13(48.15)
透析龄(月)	52.00(30.00, 146.00)
原发病[例(%)]
糖尿病	8(29.63)
高血压病	6(22.22)
原发性肾小球疾病	3(11.11)
自身免疫相关肾脏病	2(7.41)
病因不明	8(29.63)
AVF建立时间(月)	50.00(17.00,124.00)
确诊时化验资料
血红蛋白(g/L)	99.22±12.07
白蛋白(g/L)	37.69±1.29
血肌酐(μmol/L)	906.75±114.73
血尿素氮(mmol/L)	24.29±3.94
胆固醇(mmol/L)	3.70±1.00
甘油三酯(mmol/L)	1.40(1.16, 1.87)
钾(mmol/L)	4.23(3.94,4.98)
磷(mmol/L)	1.74(1.38,2.00)
钙(mmol/L)	2.03(2.00, 2.09)
甲状旁腺激素(pg/ml)	362.89±124.28
D-二聚体(mg/L)	0.38(0.14, 0.64)
临床表现[例(%)]
震颤减弱	5(18.52)
震颤消失	9(33.33)
流量下降	7(25.93)
静脉压高	2(7.41)
疼痛	3(11.11)
其他	1(3.70)
血栓形成[例(%)]	13(48.15)

项目	数值
年龄(岁)	64.55±11.58
男[例(%)]	13(48.15)
透析龄(月)	52.00(30.00, 146.00)
原发病[例(%)]
糖尿病	8(29.63)
高血压病	6(22.22)
原发性肾小球疾病	3(11.11)
自身免疫相关肾脏病	2(7.41)
病因不明	8(29.63)
AVF建立时间(月)	50.00(17.00,124.00)
确诊时化验资料
血红蛋白(g/L)	99.22±12.07
白蛋白(g/L)	37.69±1.29
血肌酐(μmol/L)	906.75±114.73
血尿素氮(mmol/L)	24.29±3.94
胆固醇(mmol/L)	3.70±1.00
甘油三酯(mmol/L)	1.40(1.16, 1.87)
钾(mmol/L)	4.23(3.94,4.98)
磷(mmol/L)	1.74(1.38,2.00)
钙(mmol/L)	2.03(2.00, 2.09)
甲状旁腺激素(pg/ml)	362.89±124.28
D-二聚体(mg/L)	0.38(0.14, 0.64)
临床表现[例(%)]
震颤减弱	5(18.52)
震颤消失	9(33.33)
流量下降	7(25.93)
静脉压高	2(7.41)
疼痛	3(11.11)
其他	1(3.70)
血栓形成[例(%)]	13(48.15)

项目	总手术次数(n=29)	江苏大学附属医院(n=20)	常州市第二人民医院(n=6)	苏北人民医院(n=3)
AVG	12	7	2	3
PTA	7	6	1	0
血管转位	8	7	1	0
自体血管间置	1	0	1	0
BV-尺动脉AVF	1	0	1	0

项目	总手术次数(n=29)	江苏大学附属医院(n=20)	常州市第二人民医院(n=6)	苏北人民医院(n=3)
AVG	12	7	2	3
PTA	7	6	1	0
血管转位	8	7	1	0
自体血管间置	1	0	1	0
BV-尺动脉AVF	1	0	1	0

组别	手术次数		技术成功率 [例(%)]	并发症 [例(%)]	随访时间 (月)			初级通畅率[例(%)]
组别	手术次数		技术成功率 [例(%)]	并发症 [例(%)]	随访时间 (月)			6月	12月		18月		24月
总数	29		26(89.66)	3(10.34)	21.00(11.75,27.50)			22(88.50)	13(69.80)		5(41.90)		2(41.90)
AVG	12		12(100.00)	2(16.70)	22.50(13.75,63.75)			10(83.30)	7(64.80)		2(21.60)		/
血管转位	8		8(100.00)	0	19.50(13.00,25.25)			8(100.00)	5(75.00)		2(75.00)		1(75.00)
PTA	7		4(57.14)	1(14.29)	8.50(5.00,10.50)			3(100.00)	/		/		/
其他	2		2(100.00)	0	24.50(23.00,24.50)			1(50.00)	1(50.00)		1(50.00)		1(50.00)
χ²/Z值			10.516	1.788	6.834			5.349	0.673		1.122		1.406
P值			0.017	0.672	0.107			0.217	0.652		0.408		0.378
组别		次级通畅率[例(%)]								总通畅率 [例(%)]		再手术概率 (次/人)
组别		6月		12月		18月	24月			总通畅率 [例(%)]		再手术概率 (次/人)
总数		25(100.00)		19(100.00)		15(100.00)	9(100.00)			22(84.61)		1.12
AVG		12(100.00)		10(100.00)		9(100.00)	5(100.00)			8(66.70)		1.67
血管转位		8(100.00)		7(100.00)		4(100.00)	2(100.00)			8(100.00)		0.75
PTA		3(100.00)		/		/	/			3(75.00)		0.50
其他		2(100.00)		2(100.00)		2(100.00)	2(100.00)			2(100.00)		0.50
χ²/Z值		/		/		/	/			1.651		9.365
P值		/		/		/	/			0.362		0.027