Emory University School of Medicine, Atlanta, GA 30308, USA.
Semin Vasc Surg. 2011 Jun;24(2):137-42. doi: 10.1053/j.semvascsurg.2011.05.014.
Vascular access dysfunction continues to be a major cause of morbidity and mortality in the end-stage renal patient. Thrombosis is the primary cause of prosthetic arteriovenous access (ie, graft) failure caused by the progressive development of neointimal hyperplasia, which eventually leads to a stenosis, usually at the venous anastomosis. More than 20 years ago, observational studies using a variety of surveillance techniques, coupled with preemptive angioplasty, convincingly demonstrated the ability to detect venous stenosis, and elective treatment of stenoses significantly decreased both thrombosis and access loss. Although multiple observational studies have shown a benefit from surveillance, these studies generally had no control population, used historical controls, or used incorrect statistical analysis. However, five randomized controlled trials that evaluated the effect of graft surveillance coupled with preemptive angioplasty have failed to demonstrate a benefit on graft outcomes, including prolongation of graft survival. This review will examine the role of access surveillance and preemptive angioplasty in achieving the goal of reducing vascular access thrombosis and prolonging access survival.
血管通路功能障碍仍然是终末期肾病患者发病率和死亡率的主要原因。血栓形成是导致人造动静脉通路（即移植物）失效的主要原因，其原因是新生内膜过度增生的逐渐发展，最终导致狭窄，通常发生在静脉吻合处。20 多年前，使用各种监测技术的观察性研究，加上预防性血管成形术，令人信服地证明了检测静脉狭窄的能力，选择性治疗狭窄显著降低了血栓形成和通路丧失的风险。尽管多项观察性研究表明监测具有益处，但这些研究通常没有对照人群，使用历史对照或使用不正确的统计分析。然而，五项评估移植物监测联合预防性血管成形术对移植物结局影响的随机对照试验未能证明在减少血管通路血栓形成和延长通路生存方面有获益，包括延长移植物的生存时间。这篇综述将探讨血管通路监测和预防性血管成形术在实现减少血管通路血栓形成和延长通路生存的目标中的作用。
