Oncevski A, Dejanov P, Gerasimovska V, Polenakovic M H
Department of Nephrology, Clinical Center, Skopje, Republic of Macedonia.
Int J Artif Organs. 2002 May;25(5):354-64. doi: 10.1177/039139880202500503.
Eight thousand eight hundred and forty nine different vascular hemodialysis accesses were performed in the period from 1976 until 1999 at the Department of Nephrology, Skopje: 3,114 native arterial-venous fistula (AVF), 715 arterial-venous shunts (AVS), 4,964 temporary or permanent catheters (4,411/88.86% femoral, 410/8.26% subclavian, 143/2.88% jugular) and 56 PTFE vascular grafts. Femoral catheterization (4,312/86.86%) is the favoured solution if a temporary vascular dialysis access is taken into consideration. The most popular chronic dialysis angio-access in our country is native AVF (90.5% of 3,440 permanent dialytic vascular accesses). The tunneled subcutaneously positioned catheters as a permanent dialytic angio-access were present in 270 cases (7.9%): 99 in femoral veins (our original method), 123 in subclavian veins and 48 catheters in jugular veins. The synthetic vascular grafts-PTFE (polytetrafluoro-ethylene) represent only 1.6% of all dialysis angio-accesses. The number of preventive AVFs created in patients with preterminal end-stage renal disease eventually increased; from 14% in the eighties, 20.8% after 10 years and 31.50% in 1999. Most of the preventive AVFs are done in outpatients 71.8% in 1999. This year 44.4% of all chronic vascular access were created in the same way. We prefer femoral catheters for both temporary and permanent access because our results show that femoral catheterization has a lower rate of early complications when compared to the subclavian catheterization group; the rate of late complications (thrombosis, stenosis, infections) is lower or the same; infections in femoral catheterizations are less frequent, compared to subclavian and jugular ones. Our contributions in the field of vascular access surgery are the three original methods which are constantly used at the Department: 1. Combination of temporary (AVS) and permanent vascular access (AVF) using the same blood vessels, performed in one surgical act; 2. Tunneled femoral catheter as a permanent vascular access for hemodialysis (2 types: on the abdominal wall and on the infrainguinal region - thigh); 3. Reduction of hyper-flow in AVF without the operation of "banding", with ligation of the artery before arteriovenous anastomosis.
1976年至1999年期间，斯科普里肾脏病科共进行了8849例不同的血管透析通路手术：3114例自体动静脉内瘘（AVF）、715例动静脉分流术（AVS）、4964例临时或永久性导管（4411例/88.86%为股静脉导管，410例/8.26%为锁骨下静脉导管，143例/2.88%为颈内静脉导管）以及56例聚四氟乙烯（PTFE）血管移植物。若考虑临时血管透析通路，股静脉置管（4312例/86.86%）是首选方法。我国最常用的慢性透析血管通路是自体AVF（在3440例永久性透析血管通路中占90.5%）。作为永久性透析血管通路的皮下隧道式导管有270例（7.9%）：99例位于股静脉（我们的原创方法），123例位于锁骨下静脉，48例位于颈内静脉。合成血管移植物——PTFE（聚四氟乙烯）仅占所有透析血管通路的1.6%。终末期肾病患者预防性建立的AVF数量最终有所增加；从八十年代的14%，到十年后的20.8%，再到1999年的31.50%。1999年，大多数预防性AVF是在门诊患者中进行的（占71.8%）。今年，所有慢性血管通路中有44.4%是以同样方式建立的。我们在临时和永久性血管通路中都更倾向于使用股静脉导管，因为我们的结果表明，与锁骨下静脉置管组相比，股静脉置管的早期并发症发生率更低；晚期并发症（血栓形成、狭窄、感染）发生率更低或相同；与锁骨下静脉和颈内静脉置管相比，股静脉置管感染较少见。我们在血管通路手术领域的贡献是该科室一直在使用的三种原创方法：1. 在同一手术操作中，利用同一血管将临时血管通路（AVS）和永久性血管通路（AVF）相结合；2. 隧道式股静脉导管作为永久性血液透析血管通路（两种类型：腹壁型和腹股沟下区域——大腿型）；3. 在不进行“绑扎”手术的情况下，通过在动静脉吻合术前结扎动脉来减少AVF中的高血流量。
