Shenoy Surendra
Washington University School of Medicine, Saint Louis, MO - USA.
J Vasc Access. 2017 Mar 6;18(Suppl. 1):1-4. doi: 10.5301/jva.5000698. Epub 2017 Mar 5.
Over the past 50 years, since Dr. Appel performed the first internal vascular access procedure for hemodialysis, the distal radiocephalic arteriovenous fistula continues to be the access of choice. Over time, failure to maturation has evolved as a major problem associated with this procedure depriving its benefits to many patients with end-stage renal disease. A variable incidence of this problem within similar patients suggests that surgical technique may play an important role in the development of non-maturation. Evaluating the current surgical techniques based on the hemodynamic consequences of anatomic and physiologic alterations following this procedure highlights the role of surgical technique in mitigating or reducing complications. Piggy-back straight line on-lay, a technique that helps to tailor the blood flow and reduce the oscillatory shear stress appears to reduce the incidence of early juxta-anastomotic problems, which contribute significantly to the problem of non-maturation.
在过去50年里，自阿佩尔医生首次进行用于血液透析的体内血管通路手术以来，桡动脉-头静脉端侧吻合内瘘仍然是首选的血管通路。随着时间的推移，内瘘成熟障碍已演变成与该手术相关的一个主要问题，使许多终末期肾病患者无法从中受益。在相似患者中，这个问题的发生率存在差异，这表明手术技术可能在非成熟性的发展中起重要作用。根据该手术后解剖和生理改变的血流动力学后果来评估当前的手术技术，突出了手术技术在减轻或减少并发症方面的作用。“背驮式”直线覆盖法是一种有助于调整血流并降低振荡剪切应力的技术，似乎能降低早期吻合口附近问题的发生率，而这些问题对非成熟性问题有很大影响。
