Department of Transplant Surgery, Western Infirmary, Glasgow, UK.
Nephrol Dial Transplant. 2012 May;27(5):2005-16. doi: 10.1093/ndt/gfr552. Epub 2012 Jan 13.
Renal failure is a major cause of morbidity in western Europe, with rising prevalence. Vascular access complications are the leading cause of morbidity among patients on haemodialysis. Considering the health care burden of vascular access failure, there is limited research dedicated to the topic.
Randomised control trials of medications aimed at improving vascular access patency were identified using a medline search between January 1950 and January 2011.
Thirteen randomised trials were identified, investigating antiplatelets, anticoagulants and fish oil in preserving vascular access patency. Outcomes are presented and reviewed in conjunction with the underlying pathophysiological mechanisms of failure of vascular access.
Vascular access failure is a complex process. Most clinical trials so far have involved medications primarily aimed at preventing thrombosis. Other contributing pathways such as neointimal hyperplasia have not been investigated clinically. Improved outcomes may be seen by linking future therapies to these pathways.
肾衰竭是西欧发病率的主要原因，其发病率呈上升趋势。血管通路并发症是血液透析患者发病率的主要原因。考虑到血管通路失败带来的医疗负担，针对该问题的研究十分有限。
通过对 1950 年 1 月至 2011 年 1 月期间的 Medline 搜索，确定了旨在改善血管通路通畅性的药物的随机对照试验。
确定了 13 项随机试验，研究了抗血小板、抗凝和鱼油在维持血管通路通畅性方面的作用。结合血管通路失败的潜在病理生理机制，对结果进行了阐述和回顾。
血管通路失败是一个复杂的过程。到目前为止，大多数临床试验都涉及主要用于预防血栓形成的药物。其他促成通路，如新生内膜增生，尚未在临床上进行研究。通过将未来的治疗方法与这些途径联系起来，可能会获得更好的结果。
