Background: The radial artery deviation and reimplantation (RADAR) technique uses an artery-to-vein (end-to-side) configuration. We have developed a modified RADAR (M-RADAR) technique. This new technique enables a side-to-side anastomosis between the vessels, and furthermore, the distal cephalic vein is ligated. The VAC Study (Paradigm Shift in Vascular Access Creation) is a multicenter randomized controlled trial comparing the clinical outcomes of radiocephalic fistula created using the conventional technique (CT group) versus the modified RADAR method (M-RADAR group).Methods: Prospective, multicenter, randomized study starting in December 2024. Participant recruitment has commenced. All data are collected via paper-based Case Report Forms (CRFs). The primary clinical endpoints include the 1-year primary patency rate of AVF and the incidence of venous juxta-anastomotic stenosis. Secondary endpoints include the 1-year access-assisted primary patency, access cumulative patency, hospitalization rates, mortality, and an analysis of the economic costs associated with maintaining vascular access. An estimated 408 participants will be recruited from approximately 29 dialysis units across China.Discussion: A high-quality, adequately powered multicenter randomized controlled trial (RCT) is still needed to provide clear guidance for clinicians on selecting optimal treatment strategies for the cephalic vein during AVF surgery.Trial registration: Registration number: ChiCTR2400093537, Registered on 2024-12-06.

To investigate the long-term outcomes and influencing factors of lower extremity arteriovenous grafts (AVGs) in maintenance hemodialysis patients. A retrospective analysis was conducted on clinical data from 96 hemodialysis patients who underwent lower extremity arteriovenous graft placement at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2013 and December 2023. Demographic characteristics, laboratory parameters, surgical details, and follow-up outcomes were recorded. Kaplan‒Meier analysis was used to assess patency rates, whereas univariate and multivariate Cox regression models were used to identify predictors of thrombosis and graft failure. The outcomes were defined according to the Society for Vascular Surgery reporting standards. The cohort had a mean age of 61.3 ± 12.5 years, with 67 females (69.8

ObjectiveTo evaluate the safety， technical success rate， primary patency， catheter survival time， and survival rate of tunneled cuffed dialysis catheters （TCC） with Dacron cuffs placed via a low puncture of the external jugular vein （EJV） under combined ultrasound and digital subtraction angiography （DSA） guidance in patients with right internal jugular vein （RIJV） occlusion requiring maintenance hemodialysis.MethodsWe retrospectively analyzed 15 maintenance hemodialysis patients with RIJV occlusion treated in the Department of Nephrology， Sir Run Run Shaw Hospital， Zhejiang University School of Medicine， from September 2021 to March 2023. All patients underwent ultrasound localization combined with real-time DSA monitoring and adjustment， with low-position puncture of the EJV at the point where it joins the subclavian vein above the midpoint of the clavicle for TCC placement. We recorded catheterization success， procedural safety， and the management of any central venous lesions. Patients were followed up for 3 months to assess primary catheter patency， catheter survival time， and survival rate.ResultsAll 15 patients achieved successful puncture and catheter placement （100% success）. Thirteen patients received right EJV catheters； two patients underwent left EJV catheterization because of complete occlusion of the right brachiocephalic （innominate） vein. Among five patients with concomitant central venous lesions， three were successfully catheterized after endovascular treatment， while two required route adjustment after failed recanalization. No major complications such as hemothorax， air embolism， arterial puncture， or malignant arrhythmia occurred. At 3 months， 14 catheters were functioning normally， yielding a primary patency rate of 93.33%； there were no catheter-related infections， dislodgements， or ruptures. Mean catheter survival time was （84.43±5.37） days， and the three-month catheter survival rate was 91.90%.ConclusionFor hemodialysis patients with RIJV occlusion， low-position EJV puncture and TCC placement using combined ultrasound and DSA real-time monitoring is a safe， highly successful， and effective method for establishing vascular access， with favorable short-term patency and survival.

OBJECTIVES:To investigate the effects of prophylactic flow restriction for brachiocephalic arteriovenous fistula on postoperative high-flow-related complications and patency rate in patients undergoing hemodialysis. METHODS:Clinical data of patients with end-stage renal disease who underwent brachiocephalic arteriovenous fistula surgery for hemodialysis from February 2017 to May 2022 in Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively analyzed. During surgery, a 4-5 mm vascular suture loop was placed around the vein near the anastomosis as a flow restriction device in 43 patients (flow restriction group), while 42 patients did not receive the prophylactic flow restriction ring (control group). All patients were followed up for 1 to 5 years. The incidence rates of complications related to the hemodialysis access pathway, including distal ischemia syndrome, the formation of arteriovenous fistula aneurysms, thrombus, high-flow congestive heart failure, anastomosis of the vein within 1 cm of the anastomosis and cephalic arch stenosis, were compared between the two groups. The natural blood flow rate of the arteriovenous fistula, anastomosis size, the internal diameter of the vein near the anastomosis, primary patency rate, assisted primary patency rate, and secondary patency rate of the arteriovenous fistula, were also evaluated and compared between the two groups. Logistic regression analysis was used to investigate the factors affecting arteriovenous fistula patency rates, as well as the impact of the flow-restricting ring on postoperative factors. RESULTS:Ultrasound measurements showed that the internal diameter of the vein at the site of the flow restriction ring in the flow restriction group was (3.7±0.6) mm at three months postoperatively, which was significantly smaller than the internal diameter of the narrowest part of the vein near the anastomosis in the control group [(4.1±1.0) mm, t=－2.416, P<0.01]. The postoperative anastomotic diameter and natural blood flow rate of the arteriovenous fistula in the flow restriction group were both significantly lower than those in the control group (both P<0.05). Furthermore, the incidence rates of various complications in the flow restriction group were significantly lower than those in the control group (all P<0.05). At 6, 12, and 24 months postoperatively, the primary patency rate and assisted primary patency rate in the flow restriction group were significantly higher than those in the control group (both P<0.05), while there was no significant difference in secondary patency rates between the two groups (P>0.05). Binary logistic regression analysis indicated that age, diabetes, and natural blood flow rate of the arteriovenous fistula at 3 months postoperatively were independent risk factors for primary patency rate, while the flow restriction for brachiocephalic arteriovenous fistula was an independent protective factor for primary patency rate (P<0.01 or P<0.05). The application of flow restriction was negatively correlated with anastomotic diameter at 6 and 12 months, natural arteriovenous fistula blood flow, and the incidence rates of cephalic arch stenosis and aneurysm formation (all P<0.05). CONCLUSIONS:The prophylactic constriction during brachiocephalic arteriovenous fistula surgery in patients undergoing hemodialysis can limit the size of the anastomosis and postoperative arteriovenous fistula blood flow, reducing complications such as cephalic arch stenosis and high-flow heart failure, and increasing primary patency rates of arteriovenous fistula and delay the reintervention of the fistula.

Background: To investigate the feasibility, methods and effects of interventional ultrasound in nitinol stent implantation to treat early restenosis after percutaneous transluminal angioplasty (PTA) in autogenous arteriovenous fistula (AVF).Methods: From April 2018 to December 2021, 69 patients with early restenosis of AVF received ultrasound-guided nitinol stent implantation (UNSI) and were followed-up. Imaging features of the stent and procedure by ultrasound were observed. The technical success rate, clinical success rate and incidence of complications were recorded and counted. Target lesion primary patency (TLPP), access circuit primary patency (ACPP) and access circuit secondary patency (ACSP) were estimated.Results: Ultrasonography can show the structure of the stent and guide the stenting process clearly. Both the technical and clinical success rates were 100%. Thirty-one patients had in-stent restenosis (ISR), which was treated by plain balloon (PB) PTA or drug coated balloon (DCB) PTA. The TLPP at 3, 6, 12 and 24 months were 100.0%, 94.2%, 63.4% and 39.6%, respectively. The ACPP at 3, 6, 12 and 24 months were 98.6%, 91.6%, 60.2% and 35.2%, respectively. The ACSP at 3, 6, 12 and 24 months were 98.6%, 98.6%, 95.6% and 93.8%, respectively. The TLPP of ISR after DCB PTA at 3, 6 and 12 months were 100.0%, 100.0% and 93.6%, respectively.Conclusions: This pilot study indicates ultrasonography can accurately guide nitinol stent implantation in AVF and this technique is a feasible and minimally invasive treatment for early restenosis after PTA with good short- and medium-term patency. DCB PTA may be used to deal with the ISR and is a way to prolong the patency of nitinol stent.

Objective: Resistant chronic total occlusion (CTO) lesions present an ongoing challenge for conventional endovascular interventions to restore functional hemodialysis (HD) access. This study endeavors to present a novel endovascular approach utilizing ultrasound (USG)-guided percutaneous sharp recanalization to cross the resistant occlusions and evaluates its effectiveness.Methods: This is a multi-center retrospective review of consecutive patients received USG guided sharp recanalization for the treatment of resistant CTO lesions of their HD access between 1st January 2019 and 31st July 2023. Data encompassing patient demographics, access and lesion characteristics, procedural specifics, associated complications, immediate clinical outcomes, and outcomes during follow-up were collected. The procedural technical and clinical success, Kaplan-Meier estimated target lesion (TLPP), access circuit primary patency (ACPP), and index access secondary patency (SP) were reported.Results: During the study period, 22 patients underwent USG-guided sharp recanalization procedures in the three participating centers with median follow-up of 14.5 months. Both the technical and clinical success were 100%. Only two patients experienced minor complications of localized hematoma over the access, with no instances of major complication. Kaplan-Meier estimated TLPP and ACPP at 3-, 6-, and 12 months were 90.9%, 68.2%, 56.8%, and 90.9%, 63.6%, 52.1% respectively. The SP rates were 100%, 95.5%, and 84.1% at 3-, 6-, and 12 months respectively.Conclusion: USG guided percutaneous sharp recanalization is an effective and safe endovascular approach to treat resistant CTO lesions of dysfunctional HD access.

Objective To explore the effect of the continuing education mode of vascular access technology under the guidance of remote ultrasound based on the cloud platform and the satisfaction of students.Methods A total of 39 training physicians who studied at 12 vascular access centers in China from January 2020 to June 2022 were selected as the research subjects.Through the cloud platform and its corresponding guidance physicians during the study period,they completed the assessment of continuous hemodialysis patient access in local hospitals and ultrasound guided percutaneous transluminal angioplasty(PTA).The training effect was evaluated by the operating process scoring scale of the training physicians and the satisfaction questionnaire of the training physicians.Results The examination of the whole process of the training physicians'operation showed that the average score of vascular evaluation skills was(88.24±4.31)points,including the scores of internal medicine evaluation,dialysis evaluation,access evaluation and surgical plan formulation:(14.29±0.52)points,(21.03±1.72)points,(37.53±1.43)points,and(15.40±2.51)points.The average score of PTA-related skills under ultrasound guidance was(88.56±3.62)points,and the number of full marks of aseptic concept,humanistic care and operation proficiency was relatively large,accounting for 94.87%,82.05%and 56.41%of the total respectively.The scores of preparations before the operation,preparation during the operation and precautions after the operation were relatively high,(18.18±1.35)points,(15.00±0.92)points,and(13.92±1.04)points,respectively.The main loss items were intraoperative ultrasound operation,guide wire operation and balloon operation.The satisfaction survey found that all the refresher physicians were satisfied with the long-distance ultrasound-guided vascular access technology education model based on the cloud platform and believed that the cloud platform guidance could stimulate learning enthusiasm,enhance independent learning ability,improve communication and language expression ability,and improve the level of ultrasound-guided vascular access technology.Conclusion The continuing medical education model of ultrasound-guided vascular access technology based on the cloud platform can provide individualized and precise guidance for training doctors.The training doctors are highly satisfied with this model,which can improve the learning efficiency of doctors,shorten the learning cycle,enhance their confidence in carrying out this technology in the local area,and promote the popularization of multichannel ultrasound-guided vascular access technology.

目的 利用超声检查探索终末期肾病患者上肢血管的基线特征,以期为我国动静脉内瘘的建立提供借鉴.方法 收集2016年7月～2020年5月在浙江大学医学院附属邵逸夫医院拟建立血液透析血管通路的终末期肾病患者307例.利用彩色多普勒超声评估上肢血管的基线特征,包括主要静脉的充盈内径、主要动脉的内径、内中膜厚度、钙化情况以及血流动力学参数.结果 307例患者前臂头静脉、上臂头静脉、前臂贵要静脉、上臂贵要静脉、肘正中静脉、肘部穿静脉的平均内径分别为(2.6±0.9)mm、(3.6±1.4) mm、(2.4±0.8)mm、(4.6±1.1)mm、(2.9±1.7)mm、(3.1±1.0)mm,上段肱动脉、下段肱动脉、上段桡动脉、下段桡动脉、上段尺动脉、下段尺动脉的平均内径分别为(4.1±0.9)mm、(4.1±0.7)mm、(2.7±0.6)mm、(2.0±0.5) mm、(3.6±0.6)mm、(1.7±0.5)mm.肱动脉、桡动脉、尺动脉的钙化发生率分别为8.8％、15.9％、23.4％,平均收缩期峰值流速分别为(63.7±19.2) cm/s、(60.6±20.9) cm/s、(58.2±20.4)cm/s,阻力指数均为(0.9±0.1).肱动脉平均血流量为(55.1±36.9)ml/min.结论 超声检查可以无创地评估患者的上肢血管条件,就血管内径而言,前臂头静脉、上臂头静脉、前臂贵要静脉、上臂贵要静脉、肘正中静脉、肘部穿支静脉中符合建立动静脉内瘘要求(≥2.0mm)的比例分别为79.5％、88.7％、70.7％、98.6％、73.3％、88.9％,下段肱动脉、下段桡动脉、下段尺动脉中符合建立要求(≥1.5mm)的比例分别为100.0％、89.6％、66.8％.

Objective:To explore the puncture management in hemodialysis patients with difficult new arteriovenous fistula based on the finest evidence-based best practice evidence and evaluate the clinical effects.Methods:A team was formed, according to theoretical framework basing on the evidence of continuous quality improvement model, the best evidence-based interventions were obtained by adopting evidence-based practice. Formulated review indicators, evaluated obstacles and promoting factors in the process of practice, and took corresponding action strategies. From February 2020 to June 2020, 30 patients admitted to the dialysis center of Sir Run Run Shaw Hospital of Zhejiang University were recruited in the baseline review group by convenience sampling method. From September 2020 to January 2021, 30 patients from September 2020 to January 2021 were recruited in the after-effect evaluation group. The baseline review group adopted the original difficult new arteriovenous fistula puncture management scheme, and the after-effect evaluation group adopted the difficult autologous new internal fistula puncture management scheme based on the best evidence. The success rate of one puncture of fistula, the incidence rate of hematoma during puncture and dialysis, the incidence rate of discontinuation of treatment and the compliance with examination indexes were compared in the patients before and after applying for the evidences.Results:Compared with the baseline review group, the success rate of one-time puncture of internal fistula in the aftereffect evaluation group increased from 36.7% (11/30) to 73.3% (22/30), the incidence rate of hematoma during puncture and dialysis were decreased from 33.3%(10/30) to 6.67%(2/30) and 40%(12/30) to 0, the incidence rate of discontinuation of treatment were decreased from 40%(12/30) to3.33% (1/30), the difference was statistically significant ( χ2 values were 6.67-11.88, P<0.05). The implementation rate of review indexes in the aftereffect evaluation group was higher than that in the baseline review group, and the difference was statistically significant ( P<0.05). Conclusions:Evidence-based practice can improve the success rate of difficult new arteriovenous fistula, and reduce the incidence of arteriovenous fistula hematoma, reduce treatment interruption, and better maintain the lifeline of patients.

Background: Percutaneous transluminal angioplasty (PTA) is an effective treatment for autogenous arteriovenous hemodialysis access (AAVA) stenosis; however, it causes pain in most cases. Therefore, safe and effective anesthesia for PTA is required. Methods: We introduced a method of ultrasound-guided cradle-like infiltration anesthesia (UCIA) to administer analgesia during PTA. Using ultrasound guidance, 1% lidocaine was injected into the bilateral and inferior perivascular spaces of the stenosis to form a cradle-like region. In this study, 100 consecutive patients were divided into two groups, and the analgesic effect of UCIA was evaluated using a numerical rating scale with non-ultrasound-guided infiltration anesthesia as a control. Meanwhile, we compared the effect of PTA between the two groups with the postoperative internal diameter of the stenosis. Results: The numerical rating scale score was 4.6 +/- 1.9 and 2.0 +/- 1.6 (P < 0.001) in UCIA group and non-ultrasound-guided infiltration anesthesia group, respectively. The postoperative internal diameter of stenosis was 3.9 +/- 0.6 mm and 4.1 +/- 0.7 mm (P = 0.113); the postoperative AAVA flow volume was 627 +/- 176 mL/min and 644 +/- 145 mL/min (P = 0.600). Conclusions: This study preliminarily showed that UCIA is effective and safe for the analgesia of AAVA PTA.

（AVF）、。201842020AVF30，（PTA）。，、，、。，100.0%。8，PTA。303、6、9、1291.3%、86.2%、86.2%、64.2%，100.0%、100.0%、86.4%、69.3%，100.0%、100.0%、100.0%、94.4%。PTA，/（<0.05）。、、、、。、AVF，PTA、。.

自2019 年12 月新型冠状病毒肺炎(COVID-19)疫情爆发以来,已经形成全球大流行.新型冠状病毒(2019-nCoV)感染可引发COVID-19,还可导致心血管、消化和泌尿等系统的病理改变[1] .肾移植受者术后长期使用免疫抑制剂,属于免疫低下人群,易发生感染及急性肾损伤[2-4] .

目的 探讨动静脉内瘘成形术前应用高频彩超对手术成功率的影响.方法 绍兴文理学院附属新昌医院及浙江大学附属邵逸夫医院2018年5月至2019年12月收治的动静脉内瘘术肾病患者60例,随机分为观察组与对照组各30例.两组均接受动静脉内瘘成形术,观察组术前应用高频彩超评估血管情况,对照组采用常规方法 评估血管情况,比较两组手术时间及一次性手术成功情况.结果 观察组一次性手术成功率93.3％高于对照组的73.3％,手术时间短于对照组,差异均有统计学意义(P<0.05).结论 高频彩超能综合评估动静脉内瘘成形术患者血管情况,提高手术成功率,缩短手术时间.

对1例尿毒症患者行腹腔镜下腹膜透析(PD)导管置入术.患者术前体格检查未发现腹股沟疝,术中腹腔镜探查发现双侧腹股沟隐匿性疝,遂行腹腔镜下PD导管置入术联合双侧腹股沟隐匿性疝无张力修补术;手术过程顺利,术后无出血、血肿、感染等并发症发生.随访2年,无疝复发、PD液渗漏和腹膜炎等并发症发生.该修补术表明,腹腔镜下PD导管置入术联合腹股沟隐匿性疝无张力修补术是安全、可行的.

目的 探讨超声引导在经皮穿刺腹膜透析导管植入术中应用的可行性、安全性、具体方法和近中期效果. 方法 回顾性纳入23例接受超声引导下经皮穿刺腹膜透析导管置入术患者.术中使用超声引导穿刺针穿入腹腔并引导导管到达目标位置.术后至少随访6个月.观察超声影像对手术过程的显示效果,统计该手术的技术成功率、术中及术后并发症(出血、肠道损伤、导管移位、堵管、渗漏、网膜包裹、腹膜炎等)发生率以及腹膜透析导管的技术生存率.结果 超声可清晰显示穿刺及置管过程,技术成功率达100.0％.导管移位1例,保守治疗后复位,透析不充分改血液透析1例,余无明显并发症.估算6个月、12个月、18个月和24个月的腹膜透析导管的技术生存率分别为100.0％、100.0％、100.0％、75.0％.结论 研究初步显示该种超声引导下经皮穿刺腹膜透析导管置入术是一种安全、可行、微创的腹膜透析置管方法,具有良好的近中期效果.

Purpose: To elucidate how miR-214 regulates the pathogenesis of diabetic nephropathy (DN). Methods: The extent of fibrosis in DN mice kidneys was examined using Masson's staining. Quantitative polymerase chain reaction (qPCR) was used to determine the levels of miR-214. Dual luciferase reporter assay was used to identify the target of miR-214. The expression of fibrosis marker proteins of high glucose-stimulated NRK-52E cells transfected with miR-214 was determined using western blotting. Results: Fibrosis in renal tissue of DN mice was significantly increased and miR-214 was upregulated (p < 0.001). Suppressor of cytokine signaling 1 protein (SOCS1) was the target gene of miR-214, and overexpression of miR-214 promoted fibrosis (p < 0.05, p < 0.001). On the other hand, overexpression of SOCS1 inhibited this process, indicating that miR-214 promoted fibrosis via targeting SOCS1 (p < 0.001). Finally, inhibition of miR-214 c ameliorated renal fibrosis in DN mice (p < 0.01, p < 0.001). Conclusions: MiR-214 is upregulated in db/db DN mice kidney tissue; miR-214 regulates renal fibrosis in DN mice by targeting SOCS1.

Objective To study the relationship between tip position and flow rate of the tunneled cuffed catheter (TCC) in femoral vein.Methodology We selected 215 cases of maintenance hemodialysis patients with TCC in femoral vein.According to X-ray examination,distal tip of the catheter was categorized into group A,group B and group C.Blood flow (ml/min) was recorded within one hour of the first hemodialysis.Blood flow was compared between the groups.Results of Kruskal-Wallis test showed that x2=11.5,Df=2 and P=0.003.Average blood flow was different between the 3 groups,with 235.3±25.5ml/min in group A,249.5± 18.1ml/min in group B and 234.7±26.8ml/min in group C.Comparison between the groups using Mann-Whitney U test showed that the difference was statistically significant in group B (P＜0.05).Conclusion Blood flow of the tunneled cuffed catheter in femoral vein was related to the position of the catheter tip.At L3 level,the blood flow was the highest.The most suitable tip position was at L3 level in inferior vena cava.The different flow rate within a group may relate to the anatomical variation of inferior vena cava.

Pharmacomechanical thrombolysis (PMT) and percutaneous transluminal angioplasty (PTA) for the treatment of acute thrombotic prosthetic arteriovenous access (PAVA) are conventionally guided by radiography, which may cause radiation injury and requires the use of radiographic contrast media. The aim of the present study was to summarize our experience with ultrasound-guided PMT and PTA as an alternative to radiographic guidance. Between December 2012 and October 2016, 114 patients with acute thrombosis of PAVA were treated urgently with ultrasound-guided PMT and PTA to restore blood flow. The patients were followed up every 3 mo postoperatively. The 114 included patients underwent 154 episodes of ultrasound-guided PMT and PTA and were followed up for a mean of 20.7 ± 9.1 mo. The technical success rate was 91.6%, and the clinical success rate was 97.4%. Post-intervention-assisted primary patency rates at 3, 6, 12 and 24 mo were 90.8%, 78.8%, 66.3% and 50.9%, respectively. Post-intervention secondary patency rates at 3, 6, 12 and 24 months were 96.3%, 94.5%, 90.6% and 85.4%, respectively. PMT and PTA for the treatment of PAVA were performed successfully under the guidance of ultrasound with a success rate similar to that under radiographic guidance, thus avoiding radiation injury and contrast medium use, although close surveillance and timely intervention are imperative to ensure long-term patency.

Objective To design and investigate the clinical effects of parallel double venous pots hemodialysis tubing set in patients with heparin-free hemodialysis.Methods Totally 120 patients who received hemodialysis therapy in our hospital from May,2014 to June,2016 were randomly divided into the experimental group (n=60) and the control group(n=60) via random number table.The experimental group received self-designed parallel double venous pots dialysis tubing set,while the control group received the normal dialysis tubing set.The number of preventive replacement of dialyzer and tubing set during heparin-free dialysis,the number of discarded tubing set due to coagulation and the time frame for the first tubing set were recoded from two groups.Results There were statistically significant differences in the number of discarded tubing set due to coagulation and the time frame for the first tubing between two groups(P＜0.05).Conclusion Parallel double venous pots dialysis tubing set can reduce the number of discarded tubing set due to coagulation,prolong the time frame for the first tubing.