Scheltinga M R, Van Hoek F, Bruyninckx C M A
Department of Surgery, Maxima Medical Center, Veldhoven - The Netherlands.
J Vasc Access. 2009 Jan-Mar;10(1):43-9. doi: 10.1177/112972980901000108.
Hemodialysis patients may develop distal ischemia in an extremity harboring a functioning arteriovenous access (AVA). Surgery is indicated if conservative treatment including catheter-based therapies fails. The role of surgical banding for refractory hemodialysis access-induced distal ischemia (HAIDI) is systematically reviewed (n=39 articles). If banding is executed without an intraoperative monitoring tool ("blind"), or guided by finger pressures only, clinical success and access patency rates are low (<50%). In contrast, banding is clinically successful when access flow is monitored during the operative procedure, with excellent long-term patency of banded AVA's (97%, 17 +/- 3 months). Banding is the method of choice in HAIDI patients with a normal or high access flow (>1.2 l/min) provided that flow and distal perfusion are closely monitored intraoperatively.
血液透析患者在拥有功能正常的动静脉内瘘（AVA）的肢体中可能会发生远端缺血。如果包括基于导管的治疗在内的保守治疗失败，则需进行手术。对手术绑扎治疗难治性血液透析通路引起的远端缺血（HAIDI）的作用进行了系统综述（共39篇文章）。如果在没有术中监测工具的情况下进行绑扎（“盲目”），或仅以手指压迫为指导，则临床成功率和通路通畅率较低（<50%）。相比之下，在手术过程中监测通路血流量时，绑扎在临床上是成功的，绑扎后的AVA长期通畅率极佳（97%，17±3个月）。对于通路血流量正常或较高（>1.2升/分钟）的HAIDI患者，只要术中密切监测血流量和远端灌注情况，绑扎就是首选方法。
