ObjectiveTo investigate the application value of 6F vascular sheath in the autogenous standard arteriovenous fistula (AVF) of fine diameter vein. MethodsA total of 100 patients with chronic renal failure ［estimated glomerular filtration rate＜20 mL/ (min·1.73 m2)］ in fine diameter vein (with cephalic vein diameter in 1.5-2.0 mm in the preoperative measurement of color Doppler ultrasound under the natural status) who underwent autogenous standard AVF were selected. The patients were randomly divided into vascular sheath surgery group (n=50) and routine surgery group (n=50). The routine surgery group received the conventional surgical method of autogenous standard AVF, before cephalic vein-radial artery anastomosis was conducted, the 6F vascular sheath was firstly employed in the vascular sheath surgery group for directly mechanical expansion and indirectly hydraulic expansion of cephalic vein, and then other operations were the same as those of the routine surgery group. The patency of internal fistula was observed on the day of surgery, and 3, 6, 12 months after surgery in both groups; furthermore, the postoperative color Doppler ultrasound was conducted to measure inner diameter of cephalic vein outflow tract, natural blood flow volume of internal fistula, to evaluate the maturation rate of internal fistula, and to record the prevalence of postoperative complications (stenosis, occlusion). ResultsThere was no statistically significant difference in the patency rate of internal fistula between the two groups on the day of surgery and 3, 6 and 12 months after surgery (all P＞0.05). The vascular sheath surgery group yielded a larger inner diameter of cephalic vein outflow tract on the second day of surgery and 1, 2, and 3 months after surgery, and larger natural blood flow volume of internal fistula 1, 2 and 3 months after surgery as compared with the routine surgery group (all P＜0.05). After a month of surgery, the maturation rate of internal fistula had no statistically significant difference between the two groups (P＞0.05). The vascular sheath surgery group yielded higher maturation rate of internal fistula in the comparison of the routine surgery group 2, 3 months after surgery (P＜0.05). After 12 months of surgery, the patients in the vascular sheath group obtained lower incidence of fistula related complications compared to the routine surgery group (P＜0.05). ConclusionEmploying 6F vascular sheath in the patients with fine diameter vein underwent autogenous standard AVF has significant surgical effects, which can expand inner diameter of cephalic vein outflow tract, increase natural blood flow volume of internal fistula, promote the maturation of internal fistula, and reduce stenosis and occlusion of internal fistula; moreover, 6F vascular sheath is cheap. Using 6F vascular sheath in the surgery to expand the blood vessel is easy to operate and safe, which is worthy of clinical promotion and application.

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