Hessinger M, Zitta S, Holzer H, Tiesenhausen K
Klinische Abteilung für Gefässchirurgie, Universitätsklinik für Chirurgie, Graz.
Zentralbl Chir. 2003 Sep;128(9):753-6. doi: 10.1055/s-2003-42754.
An adequate vascular access is the precondition for a well-functioning hemodialysis. Due to the increasing age and the rising co-morbidity of hemodialysis patients the number of those with grafts or central venous catheters (CVC) is steadily growing. The Dialock vascular access system provides a subcutaneously implantable device for hemodialysis that combines the advantages of central venous access with percutaneous puncture.
Over a period of 30 months 26 Dialock vascular access systems were implanted at our department. 17 patients were male, 9 patients female. In 11 patients the implantation of this system was indicated for internal medicine reasons. In 15 long-term hemodialysis patients implantation was carried out as ultimate solution because of persisting vascular access problems. In a comparable control group of 22 hemodialysis patients 47 vascular accesses were registered within the same period. In parallel, another 110 patients with grafts implanted at our department at that time but not put to hemodialysis at our clinic were analysed.
In a comparable number of access days the graft and the central venous catheter showed a considerably higher infection rate (Exit site + blood stream infection) per 1,000 hemodialysis access days than the vascular access device. The rate of malfunctions with or without subsequent lysis was higher using the CVC than when applying Dialock or graft. Angiographies with percutaneous transluminal angioplasty (PTA), or thrombectomies, respectively were significantly more often required with the graft than changes of catheter when using the vascular access system. More than half of the 110 patients observed at the same time, who had a graft implanted at our department without subsequent hemodialysis at our clinic had to undergo another surgical or radiologic intervention.
The Dialock access system represents in our experience a safe and with careful application less complicated vascular access device for the complex hemodialysis patient. With comparatively low infection and complication rates the Dialock vascular access system serves as a good alternative to the permanent CVC (Permcath) as well as to the graft.
充足的血管通路是血液透析正常运作的前提条件。由于血液透析患者年龄增长且合并症增多，接受移植物或中心静脉导管（CVC）治疗的患者数量在稳步增加。Dialock血管通路系统提供了一种可皮下植入的血液透析装置，它结合了中心静脉通路和经皮穿刺的优点。
在30个月的时间里，我们科室植入了26套Dialock血管通路系统。其中男性患者17例，女性患者9例。11例患者因内科原因而植入该系统。15例长期血液透析患者因持续存在血管通路问题，将植入该系统作为最终解决方案。在同期的一个由22例血液透析患者组成的可比对照组中，共记录了47次血管通路情况。同时，对当时在我们科室植入了移植物但未在我们诊所进行血液透析的另外110例患者进行了分析。
在透析天数相当的情况下，移植物和中心静脉导管每1000个血液透析通路日的感染率（出口部位感染 + 血流感染）明显高于血管通路装置。使用CVC时，无论有无后续溶栓，故障发生率均高于使用Dialock或移植物时。与使用血管通路系统更换导管相比，移植物分别更常需要进行经皮腔内血管成形术（PTA）血管造影或血栓切除术。在同期观察的110例在我们科室植入了移植物但未在我们诊所进行后续血液透析的患者中，超过一半的患者不得不接受另一次外科或放射学干预。
根据我们的经验，Dialock通路系统对于复杂的血液透析患者而言是一种安全且在谨慎使用时并发症较少的血管通路装置。Dialock血管通路系统感染率和并发症率相对较低，是永久性CVC（Permcath）以及移植物的良好替代方案。
