Kim Duk-Sil, Kim Sung-Wan, Kim Jun-Chul, Cho Ji-Hyung, Kong Joon-Hyuk, Park Chang-Ryul
Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, CHA University, Korea.
Korean J Thorac Cardiovasc Surg. 2011 Feb;44(1):25-31. doi: 10.5090/kjtcs.2011.44.1.25. Epub 2011 Feb 12.
Mature autogenous arteriovenous fistulas have better long term patency and require fewer secondary interventions compared to arteriovenous prosthetic graft. Our Study evaluated vascular patency rates and incidence of interventions in autogenous arteriovenous fistulas and grafts.
A total of 166 vascular access operations were performed in 153 patients between December 2002 and November 2009. Thirty seven caeses were excluded due to primary access failure and loss of follow-up. One group of 92 autogenous arterioveous fistulas and the other group of 37 arteriovenous prosthetic grafts were evaluated retrospectively. Primary and secondary patency rates were estimated using the Kaplan-Meier method.
The primary patency rate (84%, 67%, 51% vs. 51%, 22%, 9% at 1, 3, 5 year; p=0.0000) and secondary patency rate (96%, 88%, 68% vs. 88%, 65%, 16% at 1. 3, 5 year; p=0.0009) were better in autogenous fistula group than prosthetic graft group. Interventions to maintain secondary patency were required in 23% of the autogenous fistula group (average 0.06 procedures/patient/year) and 65% of prosthetic graft group (average 0.21 procedures/patient/year). So the autogenous fistula group had fewer intervention rate than prosthetic graft group (p=0.01) The risk factor of primary patency was diabetus combined with ischemic heart disease and the secondary patency's risk factor was age.
Autogenous arteriovenous fistulas showed better performance compared to prosthetic grafts in terms of primary & secondary patency and incidence of interventions.
与动静脉人工血管移植物相比，成熟的自体动静脉内瘘具有更好的长期通畅性，且需要的二次干预较少。我们的研究评估了自体动静脉内瘘和移植物的血管通畅率及干预发生率。
2002年12月至2009年11月期间，对153例患者进行了共166次血管通路手术。由于初次通路失败和失访，排除了37例病例。对一组92例自体动静脉内瘘和另一组37例动静脉人工血管移植物进行回顾性评估。使用Kaplan-Meier方法估计初次和二次通畅率。
自体内瘘组的初次通畅率（1年、3年、5年时分别为84%、67%、51%，而人工血管移植物组分别为51%、22%、9%；p = 〈0.0001〉）和二次通畅率（1年、3年、5年时分别为96%、88%、68%，而人工血管移植物组分别为88%、65%、16%；p = 0.0009）均优于人工血管移植物组。自体动静脉内瘘组23%的患者需要进行维持二次通畅的干预（平均0.06次手术/患者/年），人工血管移植物组为65%（平均0.21次手术/患者/年）。因此，自体动静脉内瘘组的干预率低于人工血管移植物组（p = 0.01）。初次通畅的危险因素是糖尿病合并缺血性心脏病，二次通畅的危险因素是年龄。
在初次和二次通畅率及干预发生率方面，自体动静脉内瘘比人工血管移植物表现更好。
