Golestaneh Ladan, Mokrzycki Michele H
Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
J Clin Apher. 2013 Feb;28(1):64-72. doi: 10.1002/jca.21267.
This review addresses the types of vascular access available for patients who need therapeutic apheresis (TA). As in hemodialysis, vascular access for TA is chosen based on type of procedure prescribed, the patient's vascular anatomy, the acuity, frequency and duration of treatment, and the underlying disease state. The types of access available include peripheral vein cannulation, central venous catheters: including nontunneled and tunneled catheters, arterio-venous grafts and arterio-venous fistulas. Peripheral veins and central venous catheters are most frequently utilized for the acute administration of TA, and may be used over a period of weeks to months. Arterio-venous grafts and fistulas are not commonly used in TA procedures, but are an option in patients with an anticipated long course of TA, usually for a period of several months or years. The types and frequency of complications associated with various types of vascular access, including: access dysfunction and infections are reviewed, and strategies for their prevention and management are offered.
本综述探讨了需要治疗性血液成分单采（TA）的患者可采用的血管通路类型。与血液透析一样，TA的血管通路是根据规定的操作类型、患者的血管解剖结构、治疗的紧急程度、频率和持续时间以及基础疾病状态来选择的。可用的通路类型包括外周静脉插管、中心静脉导管：包括非隧道式和隧道式导管、动静脉移植物和动静脉内瘘。外周静脉和中心静脉导管最常用于TA的急性给药，并且可以使用数周至数月。动静脉移植物和内瘘在TA操作中不常用，但对于预计TA疗程较长的患者（通常为数月或数年）是一种选择。本文回顾了与各种类型血管通路相关的并发症的类型和发生率，包括：通路功能障碍和感染，并提供了预防和管理这些并发症的策略。
