Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
Semin Vasc Surg. 2011 Jun;24(2):96-101. doi: 10.1053/j.semvascsurg.2011.05.005.
Obesity has reached an epidemic in the United States and, not surprisingly, there has been a dramatic increase in obesity-associated comorbidities, complete with a host of new, related surgical challenges. The creation and maintenance of permanent hemodialysis access, particularly autogenous access, is generally considered more difficult in the obese patient because of the increased risk of perioperative complications, as well as a decreased maturation rate. Most of the data documenting these adverse outcomes come from retrospective studies and, therefore, the reliability of the data is somewhat limited, given the inherent selection bias. In the United States, most obese patients dialyze through prosthetic access, despite the national initiatives targeted at maximizing autogenous access. However, it is possible to construct an autogenous access in most patients, including obese patients, presenting for permanent access using proper, diligent preoperative imaging and an aggressive postoperative surveillance protocol until access maturation. This is facilitated by careful preoperative planning and liberal use of multiple diagnostic and therapeutic maneuvers to improve overall access function. In this review, the outcomes associated with permanent hemodialysis access in the obese are discussed and helpful suggestions to facilitate a functional access provided.
肥胖已在美国达到流行程度，毫不奇怪，肥胖相关的合并症也急剧增加，随之而来的是一系列新的相关手术挑战。由于围手术期并发症的风险增加以及成熟率降低，肥胖患者的永久性血液透析通路（特别是自体通路）的建立和维持通常被认为更为困难。大多数记录这些不良结果的数据来自回顾性研究，因此，鉴于固有的选择偏倚，数据的可靠性有些受限。在美国，尽管国家制定了旨在最大限度地利用自体通路的计划，但大多数肥胖患者仍通过人工通路进行透析。然而，对于大多数患者，包括肥胖患者，通过适当、勤奋的术前影像学检查和积极的术后监测方案，直到通路成熟，可以构建自体通路。这得益于仔细的术前规划和广泛使用多种诊断和治疗手段来改善整体通路功能。在这篇综述中，讨论了肥胖患者永久性血液透析通路相关的结果，并提供了有助于实现功能性通路的有用建议。
