Field Melanie, Van Dellen David, Mak David, Winter Hannah, Hamsho Ahmed, Mellor Steve, Inston Nick
Renal Unit, Queen Elizabeth Hospital, Birmingham, UK.
J Vasc Access. 2011 Oct-Dec;12(4):325-30. doi: 10.5301/JVA.2011.8349.
The hemodialysis population is constantly expanding as patients on dialysis have increased longevity and the number of kidneys available for transplantation remains static (1). After radiocephalic and brachiocephalic fistulas have been exhausted the use of the autologous brachiobasilic fistula (BBAVF) should be considered prior to use of a synthetic graft. We present our single center experience of 140 brachiobasilic fistulas in a five-year period and examine any factors that influence patency and long-term function.
Patients who had undergone formation of a BBAVF between January 2004 and January 2009 were identified; a review of all case notes and databases was undertaken. Details on demographics, cause of renal failure, co-morbidities (including diabetes, cardiac morbidity, hypertension, peripheral vascular disease), dialysis status at the time of fistula creation, hemoglobin, anti-coagulation regimens, and complications from surgery were recorded.
Patency (defined as use of AVF for dialysis) was 83% at 3 months, 77% at 6 months, and 69% at 12 months. Length of patency ranged from 0 to 1918 days (at study cut-off) with a mean patency of 532 days. Factors found to significantly affect fistula patency included age over 60 (P=<0.001) and presence of peripheral vascular disease (P=0.048).
Our brachiobasilic fistula patency rates are comparable with published literature and other fistulas. Within our population patient variables including age over 60 and the presence of peripheral vascular disease are associated with worse outcomes as would be expected. In spite of these factors we feel the brachiobasilic fistula is an excellent option for patients with more challenging access and should certainly be undertaken prior to the use of prosthetic grafts.
随着透析患者寿命的延长，血液透析人群不断扩大，而可用于移植的肾脏数量保持不变（1）。在桡动脉头静脉和头臂静脉内瘘用尽后，在使用人工血管之前应考虑使用自体肱动脉尺侧静脉内瘘（BBAVF）。我们介绍了我们单中心在五年内140例肱动脉尺侧静脉内瘘的经验，并研究了影响通畅率和长期功能的任何因素。
确定2004年1月至2009年1月期间接受BBAVF成形术的患者；对所有病历和数据库进行了回顾。记录了人口统计学细节、肾衰竭原因、合并症（包括糖尿病、心脏疾病、高血压、外周血管疾病）、造瘘时的透析状态、血红蛋白、抗凝方案以及手术并发症。
通畅率（定义为使用动静脉内瘘进行透析）在3个月时为83%，6个月时为77%，12个月时为69%。通畅时间从0天至1918天（在研究截止时）不等，平均通畅时间为532天。发现显著影响内瘘通畅率的因素包括60岁以上（P<0.001）和存在外周血管疾病（P=0.048）。
我们的肱动脉尺侧静脉内瘘通畅率与已发表的文献及其他内瘘相当。在我们的患者群体中，包括60岁以上和存在外周血管疾病等患者变量与较差的结果相关，这是预期之中的。尽管存在这些因素，我们认为肱动脉尺侧静脉内瘘对于血管通路更具挑战性的患者是一个极佳的选择，并且在使用人工血管之前肯定应该考虑。
