Lee Timmy, Tindni Arshdeep, Roy-Chaudhury Prabir
Cincinnati Veterans Administration Medical Center, Cincinnati, OH, USA.
Semin Dial. 2013 Jan-Feb;26(1):85-9. doi: 10.1111/j.1525-139X.2012.01060.x. Epub 2012 Mar 9.
Due to high nonmaturation rates, arteriovenous fistulas (AVF) frequently require intervention(s) to promote maturation. Endovascular or surgical interventions are often undertaken to salvage nonmaturing AVFs. The objective of this study was to compare the impact of surgical versus endovascular interventions to promote AVF maturation on cumulative AVF survival. We evaluated 89 patients with new AVF placement from a Veterans Affairs population over a 5-year period. Of these, 46 (52%) required intervention(s) to achieve successful maturation for dialysis: 31 patients had surgical revisions and 15 patients had endovascular repairs. We compared cumulative survival between AVFs requiring no intervention, surgical revision, and endovascular intervention to promote AVF maturation. Cumulative survival was longer in AVFs receiving surgical intervention compared with angioplasty to promote AVF maturation (p = 0.05). One-year cumulative survival was 86% vs. 83% vs. 40% for no intervention vs. surgery vs. angioplasty, respectively. In AVFs that required interventions to promote maturation, AVFs with surgical intervention had longer cumulative survival compared with those AVFs with endovascular intervention. AVFs with surgical intervention to promote maturation had similar 1-year cumulative survival to those AVFs that did not require intervention to promote maturation.
由于未成熟率较高，动静脉内瘘（AVF）常常需要进行干预以促进其成熟。血管内或外科干预常常用于挽救未成熟的AVF。本研究的目的是比较外科干预与血管内干预促进AVF成熟对AVF累积生存率的影响。我们评估了在5年期间来自退伍军人事务部人群的89例新置入AVF的患者。其中，46例（52%）需要进行干预以实现透析的成功成熟：31例患者进行了外科修复，15例患者进行了血管内修复。我们比较了无需干预、外科修复和血管内干预促进AVF成熟的AVF之间的累积生存率。与血管成形术促进AVF成熟相比，接受外科干预的AVF累积生存率更长（p = 0.05）。无干预、手术和血管成形术的1年累积生存率分别为86%、83%和40%。在需要干预以促进成熟的AVF中，接受外科干预的AVF与接受血管内干预的AVF相比，累积生存率更长。接受外科干预促进成熟的AVF的1年累积生存率与那些不需要干预促进成熟的AVF相似。
