Ravani Pietro, Spergel Lawrence M, Asif Arif, Roy-Chaudhury Prabir, Besarab Anatole
Clinical Epidemiology Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
J Nephrol. 2007 Mar-Apr;20(2):141-9.
The native arteriovenous fistula (AVF) is considered the best access for hemodialysis due to its longer survival and lower complication rates as compared with other forms of vascular access. However, broad practice variation exists in the use of AVF among different countries and even within the same country among different regions and centers. Several barriers to AVF placement have been identified in the last decade that might explain its suboptimal use among both prevalent and incident patients. The present review summarizes and discusses recent findings from epidemiological studies on practice patterns and risk factors for AVF failure. Special emphasis is devoted to drawbacks and payoffs consequent upon the choice of the AVF as access for dialysis. In fact the AVF requires major investments in the short run but far less assistance and rework thereafter. Primary AVF failure, due to early failure or lack of maturation, is currently considered a key area of investigation to improve vascular access outcomes. The main challenge for the nephrologist today is to minimize the risk of primary failure while attempting to provide most patients with a native AVF. Improving vascular access outcomes is clearly a complex and difficult task. Recent experience from the United States suggests that multidisciplinary management is the most appropriate approach to deal with all the multifaceted aspects of end-stage renal disease care and to increase the likelihood of success.
与其他形式的血管通路相比，自体动静脉内瘘（AVF）因其使用寿命更长、并发症发生率更低，被认为是血液透析的最佳通路。然而，不同国家之间，甚至同一国家的不同地区和中心，在AVF的使用上存在很大差异。在过去十年中，已确定了几个影响AVF建立的障碍，这可能解释了其在现患患者和新发病患者中使用未达最佳状态的原因。本综述总结并讨论了近期关于AVF使用模式和失败风险因素的流行病学研究结果。特别强调了选择AVF作为透析通路所带来的弊端和收益。事实上，AVF在短期内需要大量投入，但此后所需的辅助和返工要少得多。由于早期失败或未成熟导致的原发性AVF失败，目前被认为是改善血管通路结局的关键研究领域。当今肾脏科医生面临的主要挑战是，在试图为大多数患者提供自体AVF的同时，尽量降低原发性失败的风险。改善血管通路结局显然是一项复杂而艰巨的任务。美国最近的经验表明，多学科管理是应对终末期肾病护理所有多方面问题并提高成功可能性的最合适方法。
