Kelm Malte, Perings Stefan M, Jax Thomas, Lauer Thomas, Schoebel Frank C, Heintzen Matthias P, Perings Christian, Strauer Bodo E
Department of Medicine, Division of Cardiology, Pulmonary Disease and Angiology, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
J Am Coll Cardiol. 2002 Jul 17;40(2):291-7. doi: 10.1016/s0735-1097(02)01966-6.
We sought to determine the incidence of arteriovenous fistulas (AVF), identify risk factors for AVF, and follow up the clinical outcome of femoral AVF.
Arteriovenous fistulas are a potential harmful complication of cardiac catheterization. Incidence and clinical outcome of iatrogenic AVF are unknown so far, although important for risk stratification and treatment.
A total of 10,271 consecutive patients undergoing cardiac catheterization were followed up prospectively over a period of three years. Diagnosis of AVF was performed by duplex sonography.
The incidence of AVF was 0.86% (n = 88). The following significant and independent risk factors for AVF were identified: high heparin dosage (odds ratio [OR]) = 2.88), coumadin therapy (OR = 2.34), puncture of the left groin (OR = 2.21), arterial hypertension (OR = 1.86), and female gender (OR = 1.84). Within 12 months 38% of all AVF closed spontaneously. No signs of cardiac volume overload or limb damage were observed in patients with persisting AVF. None of the risk factors for AVF influenced the incidence or the rate of AVF closure. Only intensified anticoagulation showed a tendency to extend AVF persistence.
Almost 1% of patients undergoing cardiac catheterization acquire femoral AVF, for which patient- and procedure-related risk factors could be identified. One-third of iatrogenic AVF close spontaneously within one year. Cardiac volume overload and limb damage are highly unlikely with AVF persistence. Thus, a conservative management for at least one year seems to be justified.
我们试图确定动静脉瘘（AVF）的发生率，识别AVF的危险因素，并随访股动静脉瘘的临床结局。
动静脉瘘是心脏导管插入术的一种潜在有害并发症。尽管医源性AVF的发生率和临床结局对于风险分层和治疗很重要，但目前尚不清楚。
对连续10271例接受心脏导管插入术的患者进行了为期三年的前瞻性随访。通过双功超声检查诊断AVF。
AVF的发生率为0.86%（n = 88）。确定了以下AVF的显著且独立的危险因素：高剂量肝素（比值比[OR]=2.88）、华法林治疗（OR = 2.34）、左腹股沟穿刺（OR = 2.21）、动脉高血压（OR = 1.86）和女性（OR = 1.84）。在12个月内，所有AVF中有38%自发闭合。持续性AVF患者未观察到心脏容量超负荷或肢体损伤的迹象。AVF的危险因素均未影响AVF的发生率或闭合率。只有强化抗凝显示出延长AVF持续时间的趋势。
接受心脏导管插入术的患者中近1%会发生股动静脉瘘，为此可识别出与患者和手术相关的危险因素。三分之一的医源性AVF在一年内自发闭合。AVF持续存在时，心脏容量超负荷和肢体损伤的可能性极小。因此，至少保守治疗一年似乎是合理的。
