Ohira Seiji, Kon Tadamasa, Imura Takashi
Sapporo Kita Clinic, Sapporo, Hokkaido, Japan.
Hemodial Int. 2006 Apr;10(2):173-9. doi: 10.1111/j.1542-4758.2006.00091.x.
The most preferable method of vascular access (VA) in maintenance hemodialysis is a native arteriovenous fistula (AVF). Advanced age as well as the rapid increase in underlying diseases such as diabetic nephropathy and nephrosclerosis in these patients also means that the veins and arteries used to establish the AVF have undergone vascular damage, making construction of an AVF more difficult compared with earlier construction. Although there are various conditions under which arterial superficialization or AV graft must be chosen, it remains the rule that the first choice for VA should be AVF whenever possible. To improve postoperative results, it is necessary to reduce malfunctions immediately following surgery. We conducted a survey of 23 dialysis facilities throughout Japan and analyzed data from the past 3 years regarding the functionality of the AVF at initial puncture following construction of 5007 examples of newly constructed AVFs. Upon initial puncture, primary failure (PF) is defined as those cases in which thrombosis or inadequate blood flow occur. Primary failure occurred in 7.6% of the cases in this series, but there was a wide distribution of PF, 0.8% to 23.6%, because of differences in quality among facilities. This difference in PF is probably affected by technical aspects, the main factor being the characteristics of the patient. Survey responses included: (1) vascular damage of the veins and arteries used in creating the AVF and (2) the suitability of the location chosen for construction. In the data collected, many methods were used to repair those primary AFVs in which PF occurred. The salvage rate was 70%. Currently, the most preferable form of VA is AVF adhering to the principle that the proper timing of the choice and construction of AVF should consider the maturation period. To accomplish this, it is vital that vascular mapping be performed preoperatively to construct the AVF. If PF does occur, the cause should be thoroughly investigated and repairs made effectively.
维持性血液透析中最理想的血管通路（VA）方法是自体动静脉内瘘（AVF）。这些患者年龄较大，且糖尿病肾病和肾硬化等基础疾病迅速增加，这也意味着用于建立AVF的动静脉已经发生血管损伤，与早期建立相比，建立AVF更加困难。尽管在各种情况下必须选择动脉浅表化或AV移植物，但VA的首选仍应尽可能是AVF。为了改善术后效果，有必要减少术后立即出现的功能障碍。我们对日本全国23家透析机构进行了调查，并分析了过去3年中5007例新建AVF建立后首次穿刺时AVF功能的数据。首次穿刺时，原发性失败（PF）定义为发生血栓形成或血流量不足的病例。本系列病例中PF发生率为7.6%，但由于各机构质量存在差异，PF分布范围较广，为0.8%至23.6%。PF的这种差异可能受技术因素影响，主要因素是患者的特征。调查回复包括：（1）建立AVF时使用的动静脉的血管损伤情况，以及（2）所选建立部位的适宜性。在收集的数据中，许多方法用于修复发生PF的原发性AVF。挽救率为70%。目前，最理想的VA形式是AVF，遵循AVF选择和建立的合适时机应考虑成熟期的原则。为此，术前进行血管造影以建立AVF至关重要。如果确实发生PF，应彻底调查原因并有效进行修复。
