Gage Shawn M, Lawson Jeffrey H
Clinical Operations, Humacyte, Inc., Morrisville, NC - USA.
Department of Surgery, Duke University Medical Center, Durham, NC - USA.
J Vasc Access. 2017 Mar 6;18(Suppl. 1):77-81. doi: 10.5301/jva.5000688. Epub 2017 Mar 5.
Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture. Operative implant strategies and risk of complications are very similar between the two configurations. Postoperative ischemia due to steal syndrome is a potential complication that requires immediate attention. Utilization of the proximal radial or ulnar artery for inflow for the graft can minimize risk of clinically relevant steal syndrome.
前臂和上臂动静脉移植物在通畅率和并发症方面表现相似。前臂动静脉移植物与上臂移植物1年时的初始通畅率分别为22%-50%和22%-42%，1年时的次级通畅率分别为78%-89%和52%-67%。2年时，前臂和上臂动静脉移植物的次级通畅率分别为30%-64%和35%-60%。充分的术前规划对于提高临床成功率至关重要，决定在一个部位而非另一个部位放置移植物应仅基于既往的血管通路史、体格检查、适当的静脉成像以及构成临床情况的其他因素。两种配置的手术植入策略和并发症风险非常相似。由于窃血综合征导致的术后缺血是一种需要立即关注的潜在并发症。利用桡动脉或尺动脉近端作为移植物的流入道可将临床相关窃血综合征的风险降至最低。
