Regus Susanne, Almási-Sperling Veronika, Rother Ulrich, Meyer Alexander, Lang Werner
Department of Vascular Surgery, University Hospital, Erlangen - Germany.
J Vasc Access. 2017 Mar 21;18(2):120-125. doi: 10.5301/jva.5000639. Epub 2017 Jan 3.
There is still an ongoing discussion about the influence of vascular surgeon experience on the immediate and long-term outcome of newly created arteriovenous fistula (AVF) for patients on hemodialysis (HD). The aim of this study was to compare failure and patency rates of AVF between experienced consultants and resident trainees with special focus on location of the anastomosis on the forearm or upper arm.
Between November 2012 and September 2016, 159 patients (83 on HD and 76 preemptive) received an AVF (90 radiocephalic [RCAVF] on the forearm; 69 brachiocephalic [BCAVF] in the elbow) by two experienced vascular surgeons (group A; n = 74) or five residents in training with one-to-four years of experience (group B; n = 85). We compared the two groups for demographic and treatment data, immediate failures (IF), bleeding complications and patency rates.
There were no significant differences in demographic data between the two groups. Vessel diameters were significantly lower for forearm compared to upper arm arteries (p = 0.026) and veins (p = 0.05). There was a significantly increased risk for IF in group B for RCAVF (p = 0.003), but not for BCAVF (p = 1.000). Furthermore, the cumulative primary patency was reduced in group B for RCAVF (p<0.001), but not for BCAVF (p = 0.899).
Surgeon experience seems to have more influence on the immediate and long-term outcome of newly created forearm AVF compared to those located on the upper arm.
关于血管外科医生的经验对接受血液透析（HD）患者新建动静脉内瘘（AVF）的近期和长期疗效的影响，目前仍在进行讨论。本研究的目的是比较经验丰富的会诊医生和住院实习医生所创建AVF的失败率和通畅率，特别关注前臂或上臂吻合口的位置。
在2012年11月至2016年9月期间，159例患者（83例HD患者和76例预先建立通路患者）接受了AVF（90例为前臂头静脉桡动脉内瘘[RCAVF]；69例为肘部肱动脉头静脉内瘘[BCAVF]），手术由两名经验丰富的血管外科医生（A组；n = 74）或五名有1至4年经验的住院实习医生（B组；n = 85）完成。我们比较了两组的人口统计学和治疗数据、近期失败率（IF）、出血并发症和通畅率。
两组的人口统计学数据无显著差异。与上臂动脉（p = 0.026）和静脉（p = 0.05）相比，前臂血管直径明显更小。B组RCAVF的IF风险显著增加（p = 0.003），但BCAVF未增加（p = 1.000）。此外，B组RCAVF的累积初级通畅率降低（p<0.001），但BCAVF未降低（p = 0.899）。
与上臂AVF相比，外科医生的经验似乎对新建前臂AVF的近期和长期疗效影响更大。
