Ultrasonic imaging anatomy and clinical application of perforating branch of median cubital vein in establishing tough hemodialysis access
10.3760/cma.j.cn441206-20200224-00090
- VernacularTitle:肘正中静脉穿通支在建立困难血液透析通路中的超声影像解剖及其临床应用
- Author:
Qiang FU
1
;
Kang WANG
;
Baochun GUO
;
Zhanghong WEI
;
Zhaokang LIU
;
Jietao HUANG
;
Yongqing ZHUANG
Author Information
1. 深圳市人民医院手显微血管外科 518020
- From:
Chinese Journal of Microsurgery
2020;43(3):272-276
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the characters of CDU imaging anatomy and results of clinical application of perforating branch of median cubital vein, and to find the evidence of utilizing perforating vein to establish high level hemodialysis access.Methods:From November, 2016 to October, 2019, 150 median cubital veins in 75 persons were observed by CDU. And the inner diameter and length of the perforating branch were measured Perforating branches of median cubital vein were categorized with ultrasonic imaging anatomy. Thirty-eight chronic kidney failure patients who can not build forearm fistulas were operated by end-to-side anastomosis between perforating branch vein and brachial artery to build hemodialysis access. The blood flow of fisultas was measured,the mature period of fisultas was recorded. The length of available vessels of fisultas was measured and the long-term utilization rate of fisultas was counted.Results:Perforating branch of median cubital vein was always located in a little below elbow near brachial artery, the rate of occurrence was 94.0%. It was sent out at intersection of veins. There were 4 types of perforating vein in image-anatomy. There was no significant difference in vessel length and vessel inner diameter between different types ( P>0.05) ; All the 38 patients with mature fistulas could meet the needs of hemodialysis. The available vascular length of fistulas in type I and type II patients was better than that in type III ( P<0.01), and the long-term utilization rates of fistulas in type I, type II and type III were 84.6%, 85.7% and 72.7%, respectively. There was no significant difference in blood flow and mature period between different types ( P>0.05) . Conclusion:It is most safe and reliable to use the type I and type II of perforating branch of median cubital vein to make the high level fistulas , which can provide a safe and efficient hemodialysis access for the patients with forearm vascular drain, elderly diabetes patients and difficult fistulas with repeatedly thrombosis.
