Olsha Oded, Goldin Ilya, Shemesh David
Department of Surgery and Hemodialysis Access Center, Shaare Zedek Medical Center, Jerusalem - Israel.
J Vasc Access. 2016 Mar;17 Suppl 1:S79-84. doi: 10.5301/jva.5000515. Epub 2016 Mar 6.
When options for autologous arteriovenous (AV) fistulas have been fully exhausted, AV grafts continue to play an important role in access creation for hemodialysis, offering long-term hemodialysis access that is a better alternative to central vein catheters. The drawbacks of AV grafts are their poor patency, infection and higher cost. Their main advantages are that they are widely available, are easy to create, and mature early. In the context of the "Fistula First" initiative, many patients with low quality veins suffer from fistula failure and non-maturation resulting in prolonged catheter days that would otherwise be prevented by initial creation of an AV graft. Endeavors to improve graft patency include administration of pharmacological agents, changing graft configuration, altering graft biology, and altering the graft surface. In this review, the current status of heparin-bonded AV grafts for hemodialysis is discussed.
当自体动静脉内瘘的选择已被充分用尽时,动静脉移植物在血液透析通路建立中仍继续发挥重要作用,提供长期血液透析通路,是中心静脉导管更好的替代方案。动静脉移植物的缺点是通畅性差、易感染且成本较高。其主要优点是广泛可用、易于建立且成熟早。在“内瘘优先”倡议的背景下,许多静脉质量差的患者存在内瘘失败和未成熟的情况,导致导管使用天数延长,而最初建立动静脉移植物本可避免这种情况。改善移植物通畅性的努力包括使用药物、改变移植物构型、改变移植物生物学特性以及改变移植物表面。在本综述中,讨论了用于血液透析的肝素结合动静脉移植物的现状。