Fassiadis Nicholas, Morsy Mohamed, Siva Mayooran, Marsh James E, Makanjuola A David, Chemla Eric S
South West Thames Surrey and Sussex Renal Transplant Unit, St. George's Healthcare NHS Trust, London, United Kingdom.
Semin Dial. 2007 Sep-Oct;20(5):455-7. doi: 10.1111/j.1525-139X.2007.00310.x.
Establishing successful long-term hemodialysis access remains a major challenge. The primary aims of this study were to determine whether primary success and primary and secondary patency rates of a series of consecutive radio-cephalic fistulae (RCF) were affected by the experience of the surgeon. The secondary aims were to assess complications, and to compare results with patency rates from the literature. All native fistulae (AVF) created in our unit between January 1, 2002 and December 31, 2005 were analyzed retrospectively. The RCF were identified and divided into group A (RCF fashioned by the consultant surgeon), and group B (fashioned by the junior surgeons within the unit). Demographic characteristics, risk factors, primary success rate (patent fistula at discharge), and primary and secondary patency rates were compared between each group using chi-squared test. During this period, 552 AVF were created. Of the 195 RCF, there were 153 fistulae in group A and 42 in group B. Median follow-up was 22 months for both groups. There was no difference with regards to age, sex ratio, prevalence of diabetes, and cardiovascular disease. The primary success rate in group A and B was 94.2% and 81%, respectively (p < 0.01). Primary and secondary patency rates at 22 months were 80%, 93%* and 74%, 81%* in group A and B, respectively (*p < 0.025). Even within group B, these results compare very favorably with the published literature. These results suggest that the placement of a RCF should be performed by the most experienced member of a team dedicated to vascular access creation or at least under his supervision.
建立成功的长期血液透析通路仍然是一项重大挑战。本研究的主要目的是确定一系列连续的桡动脉-头静脉内瘘（RCF）的初次成功率以及初次和二次通畅率是否受外科医生经验的影响。次要目的是评估并发症，并将结果与文献中的通畅率进行比较。对2002年1月1日至2005年12月31日在我们科室创建的所有自体动静脉内瘘（AVF）进行回顾性分析。识别出RCF并将其分为A组（由顾问外科医生制作的RCF）和B组（由科室初级外科医生制作的RCF）。使用卡方检验比较每组之间的人口统计学特征、危险因素、初次成功率（出院时通畅的内瘘）以及初次和二次通畅率。在此期间，共创建了552个AVF。在195个RCF中，A组有153个内瘘，B组有42个。两组的中位随访时间均为22个月。在年龄、性别比例、糖尿病患病率和心血管疾病方面没有差异。A组和B组的初次成功率分别为94.2%和81%（p<0.01）。A组和B组在22个月时的初次和二次通畅率分别为80%、93%和74%、81%（*p<0.025）。即使在B组中，这些结果与已发表的文献相比也非常有利。这些结果表明，RCF的放置应由致力于血管通路创建的团队中经验最丰富的成员进行，或者至少在其监督下进行。
