Vachharajani Tushar J
Division of Nephrology, Department of Medicine, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC.
Adv Chronic Kidney Dis. 2015 Nov;22(6):420-4. doi: 10.1053/j.ackd.2015.08.002.
The changing demographic of the hemodialysis population in the United States is posing significant challenge for selection and creation of an optimal vascular access. An arteriovenous fistula (AVF) is by far the most reliable access provided it matures and functions successfully. System-wide changes implemented by Fistula First Breakthrough Initiative and Kidney Disease Outcomes Quality Initiative guidelines have increased the awareness and incidence of AVF in the prevalent dialysis population; however, achieving the current goal of 68% AVF rate continues to remain elusive. The present article reviews the evidence in literature in support of and against using vessel mapping alone as a strategy to improve AVF rate. The current strategy of evaluating the vessels before an access is created seems to be inadequate. A patient-centered approach for an optimal vascular access needs to be considered to improve the AVF rate.
美国血液透析人群不断变化的人口结构，对选择和建立最佳血管通路构成了重大挑战。动静脉内瘘（AVF）是目前最可靠的血管通路，前提是它能成功成熟并发挥功能。通过“内瘘优先突破计划”和“肾脏疾病预后质量倡议”指南实施的全系统变革，提高了透析患者群体对AVF的认识及AVF的发生率；然而，要实现目前68%的AVF使用率目标仍很困难。本文回顾了文献中支持和反对单独使用血管造影作为提高AVF使用率策略的证据。目前在建立血管通路前评估血管的策略似乎并不充分。需要考虑采用以患者为中心的方法来建立最佳血管通路，以提高AVF使用率。
