Salman Loay, Alex Manju, Unger Stephen W, Contreras Gabriel, Lenz Oliver, Asif Arif
University of Miami Miller School of Medicine, Interventional Nephrology, Miami, FL 33136, USA.
J Am Coll Surg. 2009 Jul;209(1):100-5. doi: 10.1016/j.jamcollsurg.2009.02.050. Epub 2009 Apr 24.
The outflow vein of a dysfunctional arteriovenous dialysis access can be used to create a secondary autogenous arteriovenous fistula (SAVF) (type I). In the absence of an outflow vein, an SAVF can still be created elsewhere in the ipsilateral or contralateral extremity by identifying vessels suitable for SAVF creation (type II). But their patency rates and the use of tunneled dialysis catheters during the postoperative period have not been reported in a prospective fashion.
Patients undergoing SAVF creation were included in this analysis. Data were collected prospectively. The primary, secondary, and cumulative patency rates, along with the number of procedures required to maintain patency, were investigated. The need for tunneled dialysis catheters in patients with SAVF before the fistula was ready to support dialysis was also evaluated.
Sixty-two (type I, n=35; type II, n=27) SAVFs were created over a period of 5 years. The primary patency rates for types I and II SAVF at 6 and 12 months were 87% and 14% (type I) and 71% and 11% (type II), respectively. The secondary patency rates for type I at 12, 24, and 36 months were 100%, 100%, 83%, respectively, and for type II were 92%, 88%, 83%, respectively. The primary and secondary patency rates between the groups were not statistically significant. The cumulative patency rates for type I at 12, 24, and 36 months were 100%, 100%, 94%, respectively, and for type II were 96%, 96%, and 91%, respectively. Type I required 1.4 procedures/year, and type II needed 1.5 procedures/year (p=nonsignificant). Tunneled dialysis catheters were required in 21 patients with type I and 27 patients with type II SAVF.
Although the primary patency rates were not colossal, excellent secondary and cumulative patency rates were observed for SAVF in this study.
功能失调的动静脉透析通路的流出静脉可用于创建二级自体动静脉内瘘（SAVF）（I型）。若没有流出静脉，通过识别适合创建SAVF的血管，仍可在同侧或对侧肢体的其他部位创建SAVF（II型）。但它们的通畅率以及术后期间隧道式透析导管的使用情况尚未以前瞻性方式报道。
本分析纳入了接受SAVF创建的患者。前瞻性收集数据。研究了一级、二级和累积通畅率，以及维持通畅所需的手术次数。还评估了在瘘管准备好支持透析之前，SAVF患者对隧道式透析导管的需求。
在5年期间创建了62个SAVF（I型，n = 35；II型，n = 27）。I型和II型SAVF在6个月和12个月时的一级通畅率分别为87%和14%（I型）以及71%和11%（II型）。I型在12、24和36个月时的二级通畅率分别为100%、100%、83%，II型分别为92%、88%、83%。两组之间的一级和二级通畅率无统计学差异。I型在12、24和36个月时的累积通畅率分别为100%、100%、94%，II型分别为96%、96%、91%。I型每年需要1.4次手术，II型每年需要1.5次手术（p = 无显著性）。21例I型和27例II型SAVF患者需要隧道式透析导管。
尽管一级通畅率不高，但本研究中观察到SAVF的二级和累积通畅率良好。
