Ohira Seiji, Naito Hidemune, Amano Izumi, Azuma Nakanobu, Ikeda Kiyoshi, Kukita Kazutaka, Goto Yasuo, Sakai Shinji, Shinzato Takahiro, Sugimoto Tokuichiro, Takemoto Yoshiaki, Haruguchi Hiroaki, Hino Ichiro, Hiranaka Toshiyuki, Mizuguchi Jun, Miyata Akira, Murotani Noriyoshi
Sapporo Kita Clinic, Sapporo, Hokkaido, Japan.
Ther Apher Dial. 2006 Oct;10(5):449-62. doi: 10.1111/j.1744-9987.2006.00410.x.
The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Dr Ohira, has published an original Japanese guideline, 'Guidelines for Vascular Access Construction and Repair for Chronic Hemodialysis'. The guideline was created mainly because of the existence of numerous factors characteristic of Japanese hemodialysis therapy, which are described in this report, and because we recognized the necessity for standardization in vascular access-related surgeries. This guideline consists of 10 chapters, each of which includes guidelines, explanations or comments and references. The first chapter discusses informed consent of vascular access (VA)-related surgeries, which often resulted in trouble between dialysis staff and patients. The second chapter describes the fundamentals of VA construction and timing of the introduction of hemodialysis with emphasis on the avoidance of catheter indwelling if at all possible. In the third chapter, arteriovenous fistula (AVF) construction and management are discussed from the viewpoint of the most preferable type of VA. The fourth chapter deals with arteriovenous grafts (AVG) which has recently increased in clinical applications. The factors which improve the AVG patency rate are discussed and postoperative management methods are emphasized to avoid possible complications. The fifth chapter deals with short and long-term vascular catheters. It is emphasized that these methods are definitely effective but, at the same time, are apt to be associated with several serious complications and might result in vascular damage. In the sixth chapter, superficialization of an artery is explained. This was originally for emergency use or backup but has been used permanently in 2-3% of Japanese hemodialysis patients. In the seventh chapter, methods for the use of VA are described and the buttonhole method is referred to as one of the options for patients who complain of intense pain at every cannulation. In the eighth chapter, the importance of continuous monitoring is stressed for maintaining appropriate function of VA. As a rule, the internal shunt type VA (AVF, AVG) places a burden on cardiac function. Thus, in the ninth chapter, it is stressed that VA construction, maintenance and repair should always be carried out with consideration of cardiac function which is not constant but variable. The 10th chapter forms one of the cores of this guideline and deals with repair and timing of VA. It is shown how to select a surgical or interventional repair method. In the final 11th chapter, VA types and resultant morbidity and mortality of hemodialysis patients are reviewed.
日本透析治疗学会（JSDT）指南委员会在大平博士的主持下，发布了一份日文原创指南《慢性血液透析血管通路构建与修复指南》。制定该指南主要是因为日本血液透析治疗存在诸多独特因素（本报告对此进行了阐述），并且我们认识到血管通路相关手术需要标准化。本指南共10章，每章都包含指南、解释或说明以及参考文献。第一章讨论血管通路（VA）相关手术的知情同意问题，这一问题常常导致透析工作人员与患者之间产生纠纷。第二章描述VA构建的基本原理以及开始血液透析的时机，强调尽可能避免留置导管。第三章从最理想的VA类型角度讨论动静脉内瘘（AVF）的构建与管理。第四章涉及临床应用近期有所增加的动静脉移植物（AVG）。讨论了提高AVG通畅率的因素，并强调术后管理方法以避免可能的并发症。第五章涉及短期和长期血管导管。强调这些方法确实有效，但同时容易引发多种严重并发症，可能导致血管损伤。第六章解释了动脉浅表化。这最初是用于紧急情况或备用，但在2% - 3%的日本血液透析患者中已被长期使用。第七章描述了VA的使用方法，并提及纽扣式穿刺法是每次穿刺时主诉剧痛患者的选择之一。第八章强调持续监测对于维持VA正常功能的重要性。通常，内瘘型VA（AVF、AVG）会给心脏功能带来负担。因此，在第九章中强调，VA的构建、维护和修复应始终考虑并非恒定而是可变的心脏功能。第十章是本指南的核心内容之一，涉及VA的修复及时机。展示了如何选择手术或介入修复方法。在最后的第十一章中，回顾了VA类型以及血液透析患者由此产生的发病率和死亡率。
