Division of Nephrology, Shanghai First People's Hospital/ Jiaotong University, Shanghai, PR China.
J Nephrol. 2011 Sep-Oct;24(5):597-603. doi: 10.5301/JN.2011.6251.
The aim of this study was to investigate the use of vascular access in maintenance hemodialysis (MHD) patients and the complications of native arteriovenous fistulas (NAVFs) in a Chinese single center.
Patients (n=376) were recruited in our descriptive cross-sectional study, 350 of them had wrist NAVFs (wrist group),and 18 of them had elbow NAVFs (elbow group). We evaluated the complications associated with NAVFs and the prevalence of high-output cardiac failure between these 2 groups. All statistical analyses were performed with the use of the SPSS software package, version 17.0. Data were expressed as means ± SD; a p value <0.05 was assumed to be statistically significant.
We found 97.87% of patients had NAVFs, among them 93.09% (350/376) of patients had wrist NAVFs, followed by elbow NAVFs 4.79% (18/376), while 1.33% (5/376) had graft AVFs and only 0.80% (3/376) of patients depended on a cuff catheter. The most frequent complications seen in our patients were thrombosis (13.86%), followed by aneurysm (12.23%), anastomotic stenosis (2.17%); arterial steal syndrome (1.63%); infection (0.54%); and venous hypertension (0.27%). Aneurysm was more common in the elbow group (66.67%) than in the wrist group (9.43%) (p<0.01). There were no differences in other complications, patency rate during 1-3 years or Kt/V between the 2 groups. We did not find high-output cardiac failure related to NAVFs in our patients.
The prevalence of complications of NAVFs is high, and greater attention should be paid to the prevention of these complications. Early diagnosis and management of complications related to AVFs is essential to prevent loss of the vascular access. We think the wrist radiocephalic NAVF is the first choice for MHD patients; an elbow NAVF is a reasonable alternative for MHD access when a radiocephalic NAVF is not possible.
本研究旨在调查中国某单一中心维持性血液透析（MHD）患者血管通路的使用情况以及自体动静脉瘘（NAVF）的并发症。
我们的描述性横断面研究纳入了 376 例患者，其中 350 例为腕部 NAVF（腕部组），18 例为肘部 NAVF（肘部组）。我们评估了 NAVF 相关并发症以及两组之间高输出性心力衰竭的发生率。所有统计分析均使用 SPSS 软件包（版本 17.0）进行。数据表示为平均值±标准差；p 值<0.05 被认为具有统计学意义。
我们发现 97.87%的患者存在 NAVF，其中 93.09%（350/376）为腕部 NAVF，其次为肘部 NAVF（4.79%，18/376），而移植物动静脉瘘（AVF）占 1.33%（5/376），袖口导管仅占 0.80%（3/376）。我们的患者中最常见的并发症是血栓形成（13.86%），其次是动脉瘤（12.23%）、吻合口狭窄（2.17%）、窃血综合征（1.63%）、感染（0.54%）和静脉高压（0.27%）。肘部组的动脉瘤发生率（66.67%）高于腕部组（9.43%）（p<0.01）。两组之间的其他并发症、1-3 年内的通畅率或 Kt/V 均无差异。我们未发现与 NAVF 相关的高输出性心力衰竭。
NAVF 并发症的发生率较高，应更加重视这些并发症的预防。早期诊断和处理与 AVF 相关的并发症对于防止血管通路丧失至关重要。我们认为腕部桡尺侧动静脉瘘是 MHD 患者的首选；当桡尺侧动静脉瘘不可用时，肘部 NAVF 是一种合理的替代选择。
