Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK 74135, USA.
Semin Vasc Surg. 2011 Jun;24(2):72-81. doi: 10.1053/j.semvascsurg.2011.05.009.
An autogenous arteriovenous hemodialysis access (AVF) remains the consensus-recommended vascular access for individuals requiring hemodialysis. Surgical options, strategies, and guidelines have been established by several organizations, including the National Kidney Foundation, the Fistula First Breakthrough Initiative, and the Society for Vascular Surgery. Establishing a successful AVF in a high percentage of patients requires a thorough knowledge of the many access options and clinical practice recommendations, in addition to a careful clinical history/physical examination, pre- and postoperative ultrasound, and further vascular imaging in select patients. The more common AVF configurations may not be possible in complex patients because of limited venous outflow, arterial insufficiency, or both. However, the vascular access surgeon may still be able to construct a successful AVF in these challenging patients by utilizing one of several alternative procedures. Avoiding prosthetic arteriovenous accesses and central venous catheter-based dialysis is feasible in most patients. This article reviews some of the alternative options for establishing successful AVFs.
自体动静脉血液透析通路（AVF）仍然是需要血液透析的患者的共识推荐的血管通路。包括美国肾脏病基金会、瘘管优先突破倡议和血管外科学会在内的多个组织已经制定了手术选择、策略和指南。为了在大多数患者中建立高成功率的 AVF，需要对多种通路选择和临床实践建议有深入的了解，此外还需要仔细的临床病史/体格检查、术前和术后超声检查，以及在特定患者中进行进一步的血管成像。由于静脉流出量有限、动脉功能不全或两者兼而有之，复杂患者可能无法采用常见的 AVF 配置。然而，血管通路外科医生仍然可以通过使用几种替代手术之一来为这些具有挑战性的患者建立成功的 AVF。在大多数患者中，避免使用人造动静脉通路和基于中心静脉导管的透析是可行的。本文回顾了建立成功 AVF 的一些替代选择。
