Jean-Baptiste Elixène, Hassen-Khodja Réda, Haudebourg Pierre, Declemy Serge, Batt Michel, Bouillanne Pierre Jean
Service de Chirurgie Vasculaire, Hôpital Saint Roch, University Hospital of Nice, 5 rue Pierre Dévoluy, Nice, France.
J Vasc Surg. 2008 Jan;47(1):138-43. doi: 10.1016/j.jvs.2007.09.059.
This study reports our midterm results with arteriovenous axillary loop grafts (AVALG) and evaluates their role in construction of vascular access for patients on chronic hemodialysis.
The clinical data of 27 patients who underwent construction of an AVALG for hemodialysis access at our institution between July 2002 and December 2006 were analyzed retrospectively. Outcome measures included graft patency, the complication rate, and the frequency and morbidity of secondary procedures after AVALG creation. The Kaplan-Meier method was used to calculate the primary and secondary patency curves.
AVALG was constructed as the first access procedure in eight patients: five patients with no suitable vein to construct an adequate angioaccess on the upper limbs, and three patients with elbow and forearm arteritis. The 19 other patients had all had two to five failed prior vascular accesses leading to exhaustion of venous access sites on the upper extremities (18 cases), or a steal syndrome (one case). No postoperative death occurred, but four patients died of causes unrelated to the intervention between the second and the tenth postoperative months. The mean follow-up was 15 months (range, 2-48 months). The primary patency rate at 12 months and the secondary patency rate at 18 months were 51% and 80%, respectively. Infection (three cases), thrombosis (seven cases), and stenosis of the outflow vein (two cases) were the main complications, occurring in 10 of the 27 patients (41%). Twelve secondary procedures were performed in these 10 patients with little additional morbidity. Five of the 27 patients developed irreversible AVALG occlusion leading to access loss: two patients with concomitant graft infection and three patients with a history of subclavian vein catheterization.
AVALG may represent a supplementary option for chronic hemodialysis patients with vascular steal or inadequate upper extremity venous access sites.
本研究报告我们使用腋动静脉袢式移植物（AVALG）的中期结果，并评估其在慢性血液透析患者血管通路构建中的作用。
回顾性分析2002年7月至2006年12月在我院接受AVALG构建以建立血液透析通路的27例患者的临床资料。观察指标包括移植物通畅率、并发症发生率以及AVALG创建后二次手术的频率和发病率。采用Kaplan-Meier法计算初次和二次通畅曲线。
8例患者将AVALG作为首次通路构建手术：5例患者上肢没有合适的静脉来构建足够的血管通路，3例患者患有肘部和前臂动脉炎。其他19例患者此前均有2至5次血管通路失败，导致上肢静脉通路部位用尽（18例），或发生窃血综合征（1例）。术后无死亡病例，但有4例患者在术后第2至10个月死于与干预无关的原因。平均随访时间为15个月（范围2至48个月）。12个月时的初次通畅率和18个月时的二次通畅率分别为51%和80%。感染（3例）、血栓形成（7例）和流出静脉狭窄（2例）是主要并发症，27例患者中有10例（41%）发生。这10例患者共进行了12次二次手术，额外发病率较低。27例患者中有5例发生不可逆的AVALG闭塞，导致通路丧失：2例伴有移植物感染，3例有锁骨下静脉置管史。
对于患有血管窃血或上肢静脉通路部位不足的慢性血液透析患者，AVALG可能是一种补充选择。
