Ocala Heart Institute, Munroe Regional Medical Center, Ocala, Florida, USA.
JACC Cardiovasc Interv. 2010 Jan;3(1):1-11. doi: 10.1016/j.jcin.2009.10.021.
More than 1 in 1,000 patients in the U.S. has end-stage renal disease, and most patients who require renal-replacement therapy undergo hemodialysis. By the year 2020, more than 750,000 patients are expected to have end-stage renal disease, and over 500,000 will require hemodialysis. The greatest limitation of hemodialysis is the finite durability of hemodialysis accesses, which on average remain patent for <3 years but are the lifeline for hemodialysis patients. Catheter-based interventions are successful in restoring flow in more than 80% of hemodialysis accesses that undergo thrombosis and have replaced surgical revision as the treatment of choice for failing or thrombosed accesses. Catheter-based interventions have improved the quality of life for hemodialysis patients by reducing the need for temporary hemodialysis catheters and have prolonged total survival time by preserving existing access sites and by saving venous segments for future access creation. This review discusses the pathophysiology of dialysis access failure, presents the success rates of catheter-based treatments, and illustrates the interventional approaches for treating failing and thrombosed fistulas and grafts.
美国每 1000 名患者中就有 1 名以上患有终末期肾病，而大多数需要肾脏替代治疗的患者都接受血液透析。到 2020 年，预计将有超过 75 万名患者患有终末期肾病，其中超过 50 万名患者将需要血液透析。血液透析的最大限制是血液透析通路的有限耐用性，平均而言，其通畅时间<3 年，但却是血液透析患者的生命线。基于导管的介入治疗在恢复血栓形成的血液透析通路中的成功率超过 80%，并已取代手术修复成为失败或血栓形成的通路的治疗选择。基于导管的介入治疗通过减少对临时血液透析导管的需求，以及通过保留现有通路部位和为未来通路创建保存静脉段，提高了血液透析患者的生活质量，并延长了总生存时间。这篇综述讨论了透析通路衰竭的病理生理学，介绍了基于导管的治疗方法的成功率，并说明了治疗失败和血栓形成的瘘管和移植物的介入方法。
