Keuter X H A, Kessels A G H, de Haan M H, van der Sande F M, Tordoir J H M
Department of Surgery, University Hospital Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2008 May;35(5):619-24. doi: 10.1016/j.ejvs.2007.11.004. Epub 2008 Jan 2.
Ischemia is a devastating complication after arteriovenous fistula (AVF) creation. When not timely corrected, it may lead to amputation. Symptomatic ischemia occurs in 3.7-5% of the hemodialysis population. Upper arm AVFs have a higher incidence of ischemia compared to forearm AVFs. As more patients may need upper arm AVFs in the growing and older hemodialysis population, occurrence of symptomatic ischemia may increase. The purpose of this study is to identify predictors for occurrence of ischemia.
A prospective evaluation of ischemia was performed in patients randomised for either a brachial-basilic (BB-) AVF or a prosthetic forearm loop AVF. Clinical parameters, preoperative vessel diameters, access flows, digital blood pressures, digit-to-brachial indices (DBI) and interventions for ischemia were recorded.
Sixty-one patients (BB-AVF 28) were studied. Seventeen patients (BB-AVF 8) developed ischemic symptoms. Six patients (BB-AVF 3) needed interventions for severe symptoms. Age, history of peripheral arterial reconstruction and radial artery volume flow were significant predictors for the occurrence of ischemia.
Symptomatic ischemia occurred in 28% of patients with brachial-basilic and prosthetic forearm AVFs. Age, history of peripheral arterial reconstruction and radial artery volume flow might be important for prediction of ischemia.
缺血是动静脉内瘘（AVF）建立后的一种严重并发症。若不及时纠正，可能导致截肢。有症状的缺血在3.7% - 5%的血液透析人群中出现。与前臂动静脉内瘘相比，上臂动静脉内瘘缺血的发生率更高。随着血液透析人群的增长和老龄化，越来越多的患者可能需要上臂动静脉内瘘，有症状缺血的发生率可能会增加。本研究的目的是确定缺血发生的预测因素。
对随机接受肱动脉 - 贵要静脉（BB -）动静脉内瘘或人工血管前臂袢动静脉内瘘的患者进行缺血的前瞻性评估。记录临床参数、术前血管直径、通路血流量、指端血压、指臂指数（DBI）以及针对缺血的干预措施。
研究了61例患者（BB - 动静脉内瘘28例）。17例患者（BB - 动静脉内瘘8例）出现缺血症状。6例患者（BB - 动静脉内瘘3例）因严重症状需要干预。年龄、外周动脉重建史和桡动脉血流量是缺血发生的重要预测因素。
肱动脉 - 贵要静脉和人工血管前臂动静脉内瘘患者中有28%出现有症状缺血。年龄、外周动脉重建史和桡动脉血流量可能对缺血的预测很重要。
