Hammes Mary, Funaki Brian, Coe Fredric L
Department of Medicine, University of Chicago, Chicago, Illinois, U.S.A.
Hemodial Int. 2008 Jan;12(1):85-9. doi: 10.1111/j.1542-4758.2008.00246.x.
Numerous studies have identified the fistula as the best access for hemodialysis with fewest complications. The radiocephalic fistula (RCF) is the first access of choice, but often results in poor maturation. Therefore, an increased number of brachiocephalic fistulas (BCF) have been placed. Cephalic arch stenosis (CAS) can occur in patients with fistula access. The current study was done to determine the incidence and associated comorbidities in patients with BCF or RCF who have CAS. A retrospective review of 450 hemodialysis patients in 3 outpatient hemodialysis units between July 1, 2000 and July 1, 2005 (60 months) was preformed. We reviewed demographics, medications, and indications for venograms. Interventional Radiologists reviewed the venograms for evidence of CAS. Radiology reports were screened to determine incidence of thrombosis, treatment with either angioplasty or stent placement and if a complication such as venous rupture occurred. One hundred and twenty-seven patients had fistula access with at least 1 venogram. Of these, 30 were RCF and 97 were BCF. Cephalic arch stenosis occurred in 77% of patients with BCF and in 20% of patients with RCF. Those with diabetes had a lower rate of occurrence than those without (p<0.01). Cephalic arch stenosis led to a high rate of thrombosis (p<0.01). The probability of having multiple radiology procedures was higher with CAS than without (p<0.01). Cephalic arch stenosis is an important problem in hemodialysis patients who have fistula access, and contributes to thrombosis. Diabetes was found to have a negative association with CAS for undefined reasons. Attempts to understand this relationship are important.
众多研究已确定动静脉内瘘是并发症最少的血液透析最佳通路。桡动脉-头静脉内瘘（RCF）是首选的初始通路，但常常导致成熟不佳。因此，头臂动静脉内瘘（BCF）的置入数量有所增加。动静脉内瘘通路的患者可能发生头静脉弓狭窄（CAS）。本研究旨在确定患有CAS的BCF或RCF患者的发生率及相关合并症。对2000年7月1日至2005年7月1日（60个月）期间3个门诊血液透析单元的450例血液透析患者进行了回顾性研究。我们查阅了人口统计学资料、用药情况以及静脉造影的指征。介入放射科医生对静脉造影进行评估以寻找CAS的证据。筛查放射学报告以确定血栓形成的发生率、血管成形术或支架置入治疗情况以及是否发生了诸如静脉破裂等并发症。127例患者有动静脉内瘘通路且至少进行了1次静脉造影。其中，30例为RCF，97例为BCF。BCF患者中77%发生了头静脉弓狭窄，RCF患者中20%发生了头静脉弓狭窄。糖尿病患者的发生率低于非糖尿病患者（p<0.01）。头静脉弓狭窄导致血栓形成的发生率较高（p<0.01）。有CAS的患者进行多次放射学检查的可能性高于无CAS的患者（p<0.01）。头静脉弓狭窄是有动静脉内瘘通路的血液透析患者的一个重要问题，并会导致血栓形成。发现糖尿病与CAS存在负相关，原因不明。试图理解这种关系很重要。
