Moran John E, Prosl Frank
Satellite Healthcare, Mountain View, Calif., USA.
Contrib Nephrol. 2004;142:178-92. doi: 10.1159/000074861.
Subcutaneous hemodialysis access systems represent a uniquely different hemodialysis access option. The ideal role for these devices is to help patients to achieve a functioning AV fistula by providing temporary access while patients are waiting for the creation or maturation of an AV fistula. An ideal bridge device would allow for immediate use following placement, provide blood flow rates sufficient to ensure adequate dialysis, have a low complication rate, and have sufficient length of technical survival to allow AV fistula development and maturation without the need for device replacement. Clinical data reported to date supports the use of subcutaneous hemodialysis access systems as a bridge device instead of a hemodialysis catheter [11, 12, 17-20]. The increased emphasis on AV fistula placements in patient populations who are at higher risk of having fistulas that fail to mature increases the need for a bridge device which provides improved outcomes during longer maturation periods especially in patients in whom more than one fistula attempt is made or for patients who are receiving upper arm fistulas [21, 36]. Several studies have also documented the utility of subcutaneous hemodialysis access systems in catheter-dependent patients who have exhausted other access options [12-15, 19, 20]. The hope offered for improved outcomes in this patient population should be tempered by realistic expectations for device performance especially in patients with significant morbidities, poor vasculature, a history of poorly performing hemodialysis catheters, or multiple catheter-related infections. Totally subcutaneous hemodialysis access systems offer a unique option for ESRD patients. The development of these devices represent a key step towards improving dialysis delivery and hemodialysis vascular access-related outcomes. Following recommended procedures for implanting, accessing and maintaining these devices is key towards achieving optimal device performance.
皮下血液透析通路系统是一种截然不同的血液透析通路选择。这些装置的理想作用是在患者等待动静脉内瘘建立或成熟时提供临时通路，帮助患者获得功能良好的动静脉内瘘。理想的桥接装置应在植入后即可立即使用，提供足以确保充分透析的血流量，并发症发生率低，并且具有足够长的技术存活期，以使动静脉内瘘得以发育和成熟，而无需更换装置。迄今为止报告的临床数据支持将皮下血液透析通路系统用作桥接装置而非血液透析导管[11, 12, 17 - 20]。在动静脉内瘘成熟失败风险较高的患者群体中，对动静脉内瘘置入的重视程度增加，这就更需要一种桥接装置，尤其是在那些进行了不止一次内瘘尝试的患者或接受上臂内瘘的患者中，在更长的成熟期间能提供更好的结果[21, 36]。多项研究还记录了皮下血液透析通路系统在已用尽其他通路选择的依赖导管患者中的效用[12 - 15, 19, 20]。对于改善该患者群体的预后所抱有的希望，应结合对装置性能的现实期望，尤其是在患有严重疾病、血管状况不佳、有血液透析导管使用效果不佳病史或有多次导管相关感染的患者中。完全皮下血液透析通路系统为终末期肾病患者提供了一种独特的选择。这些装置的开发是朝着改善透析实施和血液透析血管通路相关结果迈出的关键一步。遵循植入、使用和维护这些装置的推荐程序是实现最佳装置性能的关键。
