Griffin Andrew S, Gage Shawn M, Lawson Jeffrey H, Kim Charles Y
Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC.
Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
J Vasc Surg. 2017 Jan;65(1):136-141. doi: 10.1016/j.jvs.2016.07.114. Epub 2016 Sep 26.
This study evaluated whether the use of a staged Hemodialysis Reliable Outflow (HeRO; Merit Medical, South Jordan, Utah) implantation strategy incurs increased early infection risk compared with conventional primary HeRO implantation.
A retrospective review was performed of 192 hemodialysis patients who underwent HeRO graft implantation: 105 patients underwent primary HeRO implantation in the operating room, and 87 underwent a staged implantation where a previously inserted tunneled central venous catheter was used for guidewire access for the venous outflow component. Within the staged implantation group, 32 were performed via an existing tunneled hemodialysis catheter (incidentally staged), and 55 were performed via a tunneled catheter inserted across a central venous occlusion in an interventional radiology suite specifically for HeRO implantation (intentionally staged). Early infection was defined as episodes of bacteremia or HeRO infection requiring resection ≤30 days of HeRO implantation.
For staged HeRO implantations, the median interval between tunneled catheter insertion and conversion to a HeRO graft was 42 days. The overall HeRO-related infection rate ≤30 days of implantation was 8.6% for primary HeRO implantation and 2.3% for staged implantations (P = .12). The rates of early bacteremia and HeRO resection requiring surgical resection were not significantly different between groups (P = .19 and P = .065, respectively), nor were age, gender, laterality, anastomosis to an existing arteriovenous access, human immunodeficiency virus status, diabetes, steroids, chemotherapy, body mass index, or graft location. None of the patient variables, techniques, or graft-related variables correlated significantly with the early infection rate.
The staged HeRO implantation strategy did not result in an increased early infection risk compared with conventional primary implantation and is thus a reasonable strategy for HeRO insertion in hemodialysis patients with complex central venous disease.
本研究评估了与传统的原发性血液透析可靠流出道（HeRO；美德医疗公司，南乔丹，犹他州）植入策略相比，采用分期HeRO植入策略是否会增加早期感染风险。
对192例行HeRO移植物植入的血液透析患者进行回顾性分析：105例患者在手术室接受原发性HeRO植入，87例接受分期植入，其中先前插入的带隧道中心静脉导管用于引导静脉流出道组件的导丝进入。在分期植入组中，32例通过现有的带隧道血液透析导管进行（偶然分期），55例通过在介入放射科专门为HeRO植入而插入的穿过中心静脉闭塞的带隧道导管进行（有意分期）。早期感染定义为HeRO植入后≤30天内发生的菌血症或需要切除的HeRO感染。
对于分期HeRO植入，带隧道导管插入与转换为HeRO移植物之间的中位间隔时间为42天。植入后≤30天的总体HeRO相关感染率，原发性HeRO植入为8.6%，分期植入为2.3%（P = 0.12）。两组之间早期菌血症和需要手术切除的HeRO切除率无显著差异（分别为P = 0.19和P = 0.065），年龄、性别、侧别、与现有动静脉通路的吻合、人类免疫缺陷病毒状态、糖尿病、类固醇、化疗、体重指数或移植物位置也无显著差异。患者变量、技术或移植物相关变量均与早期感染率无显著相关性。
与传统的原发性植入相比，分期HeRO植入策略并未导致早期感染风险增加，因此对于患有复杂中心静脉疾病的血液透析患者，是一种合理的HeRO插入策略。
