Ott U, Sperschneider H
KfH-Nierenzentrum Jena, Zur Lämmerlaide 1, 07751 Jena, Germany.
Chirurg. 2012 Sep;83(9):775-8. doi: 10.1007/s00104-012-2302-1.
Vascular access is the lifeline of hemodialysis patients. The superiority of autogenous arteriovenous fistulas compared to prostethic arteriovenous grafts or a central venous catheter is well established. Fistulas have a far lower risk of failure and a reduced requirement for revision compared to prosthetic grafts. Alternative vascular access can be achieved via a prosthetic graft or permanent central venous catheter but the risk of infection is increased. The most important complications are shunt thrombosis, stenosis, aneurysms or steal syndrome. Signs of these complications should be recognized by the dialysis team and early surgical intervention can avoid major complications. In many cases a complex shunt is necessary if the patient has been on dialysis for a long time. Interaction between the dialysis team, nephrologists, surgeons and interventional radiologists can improve the prognosis of dialysis patient.
血管通路是血液透析患者的生命线。自体动静脉内瘘相较于人工动静脉移植物或中心静脉导管的优越性已得到充分证实。与人工移植物相比，内瘘的失败风险要低得多，且修复需求也减少。可通过人工移植物或永久性中心静脉导管实现替代血管通路，但感染风险会增加。最重要的并发症是分流血栓形成、狭窄、动脉瘤或窃血综合征。透析团队应识别出这些并发症的体征，早期手术干预可避免严重并发症。在许多情况下，如果患者长期接受透析，则需要一个复杂的分流。透析团队、肾病学家、外科医生和介入放射科医生之间的协作可以改善透析患者的预后。
