Fitzgerald Jason T, Schanzer Andres, Chin Andrew I, McVicar John P, Perez Richard V, Troppmann Christoph
Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.
Arch Surg. 2004 Feb;139(2):201-8. doi: 10.1001/archsurg.139.2.201.
Radiocephalic fistulas for maintenance hemodialysis access are not feasible in all patients with end-stage renal disease. Our aim was to review our experience with 3 types of upper arm arteriovenous fistula (AVF) to ascertain whether they are reasonable alternatives to radiocephalic fistulas and which, if any, have superior performance.
Patient medical records were retrospectively reviewed. The main outcomes were maturation rate, time to maturation, assisted maturation rate, complication rates, reintervention rates, primary and assisted primary patency rates, and effects of comorbidities.
Eighty-six patients with end-stage renal disease underwent creation of a brachiocephalic, brachiobasilic, or brachial artery-to-median antecubital vein AVF. Overall, 80% matured, with 23% requiring an intervention to achieve maturity. The mean time to maturation was 3.8 months; 47% had a complication (inability to access, thrombosis, and so on), and 43% required additional interventions. The overall primary patency and assisted primary patency rates at 12 months were 50% and 74%, respectively. Brachiobasilic AVFs not superficialized immediately often needed a second operation. There were no significant differences in patency rates among the 3 AVF types. The AVFs in patients with diabetes took 2 months longer to mature than did those in patients without diabetes.
An upper arm AVF is a reasonable alternative for maintenance hemodialysis access when a radiocephalic AVF is not possible. There are 3 valid options from which to choose to best accommodate each patient's antecubital anatomy. Diabetes may adversely affect outcomes. Our data suggest that brachiobasilic AVFs should be superficialized at the initial procedure, if feasible.
对于所有终末期肾病患者而言，用于维持性血液透析通路的桡动脉-头静脉内瘘并非都可行。我们的目的是回顾我们使用3种类型上臂动静脉内瘘（AVF）的经验，以确定它们是否是桡动脉-头静脉内瘘的合理替代方案，以及哪种（如果有的话）具有更好的性能。
对患者的病历进行回顾性分析。主要观察指标为成熟率、成熟时间、辅助成熟率、并发症发生率、再次干预率、初次和辅助初次通畅率以及合并症的影响。
86例终末期肾病患者接受了头臂型、肱动脉-尺侧腕屈肌静脉或肱动脉至肘正中静脉AVF的建立。总体而言，80%的内瘘成熟，其中23%需要干预才能达到成熟。成熟的平均时间为3.8个月；47%出现并发症（无法使用、血栓形成等），43%需要额外干预。12个月时的总体初次通畅率和辅助初次通畅率分别为50%和74%。未立即浅表化的肱动脉-尺侧腕屈肌静脉AVF通常需要二次手术。3种AVF类型之间的通畅率无显著差异。糖尿病患者的AVF成熟时间比非糖尿病患者长2个月。
当无法建立桡动脉-头静脉AVF时，上臂AVF是维持性血液透析通路的合理替代方案。有3种有效的选择，可以根据每个患者的肘前解剖结构进行最佳选择。糖尿病可能会对结果产生不利影响。我们的数据表明，如果可行，肱动脉-尺侧腕屈肌静脉AVF应在初次手术时进行浅表化处理。
