Crowley Steven D, Butterly David W, Peter Robert H, Schwab Steve J
Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA.
Am J Kidney Dis. 2002 Oct;40(4):852-5. doi: 10.1053/ajkd.2002.35701.
In patients with end-stage renal disease undergoing hemodialysis, the upper extremity arteriovenous (AV) fistula is the dialysis access recommended by the DOQI guidelines for patients with appropriate vasculature. Upper extremity AV fistulae have long periods of usefulness, high flow rates, and low associated complication rates. Placement of AV access may result in increased cardiac output and increased cardiac oxygen demand in these patients. In general, cardiovascular complications from AV access have been limited. We report a novel cardiovascular complication of AV access in an end-stage renal disease patient with a coronary artery bypass graft employing the left internal mammary artery who experienced angina while undergoing hemodialysis. The angina was mediated at least in part by cardiac catheterization laboratory-documented steal of blood flow from the internal mammary artery graft. This phenomenon suggests the need to consider the impact of upper extremity access placement on blood flow to the left internal mammary artery in patients who previously have undergone placement of a coronary artery bypass graft.
在接受血液透析的终末期肾病患者中，上肢动静脉（AV）内瘘是血管条件合适的患者经DOQI指南推荐的透析通路。上肢AV内瘘使用期限长、血流量高且相关并发症发生率低。建立AV通路可能会导致这些患者的心输出量增加和心脏氧需求增加。一般来说，AV通路引起的心血管并发症较为少见。我们报告了1例终末期肾病患者出现的一种新型AV通路心血管并发症，该患者接受了采用左乳内动脉的冠状动脉旁路移植术，在血液透析期间发生了心绞痛。心绞痛至少部分是由心导管室记录的从乳内动脉移植物盗血介导的。这种现象表明，对于先前已接受冠状动脉旁路移植术的患者，有必要考虑上肢通路建立对流向左乳内动脉血流的影响。
