Chisci Emiliano, Harris Linda M, Menici Francesco, Frosini Pierfrancesco, Romano Eugenio, Troisi Nicola, Ercolini Leonardo, Michelagnoli Stefano
Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence - Italy.
Division of Vascular Surgery, University at Buffalo, State University of New York, New York - USA.
J Vasc Access. 2017 Sep 11;18(5):379-383. doi: 10.5301/jva.5000742. Epub 2017 Jul 26.
To study the outcomes of three different types of native arteriovenous fistula (AVF), the distal (D: radial-cephalic), middle-arm (MA: radial-cephalic) and proximal (P: brachial-cephalic) AVF access creation for hemodialysis patients in a single center.
An 8-year retrospective review, from 2006 to 2014, was conducted at a single institution in which the surgical outcomes for three different types of native AVF creation were reviewed. Preoperative duplex vein mapping was obtained in all patients to choose the best vein and site for access.
There were 317 patients identified with 41 D-AVFs, 120 MA-AVFs and 156 P-AVFs. Younger patients with a lower Charlson's Index were more frequent in the D-AVF group (p = 0.02). Mean operating room time was 15 minutes longer for the MA-AVF group than the two others (p = 0.018). Early failure (thrombosis at 30-day), one-year patency, one-year primary AVF functional patency for the D-AVF, MA-AVF, and P-AVF groups were 2.4% (n = 1), 8% (n = 1), 3.8% (n = 6), (p = 0.14); 97.6% (n = 39), 99% (n = 117), 89% (n = 129), (p<0.001); 80.5% (n = 33), 75.8% (n = 91), and 61.5% (n = 96) (p<0.001), respectively. Reintervention for fistula maturation was required in 17% (n = 7), 23% (n = 28), and 24% (n = 38) (p<0.01). The one-year venipuncture hematoma and steal syndrome occurrences were 9.7% (n = 4), 6.7% (n = 8), 3.8% (n = 6) (p = 0.06); and 0%, 0% and 3.8% (n = 6) (p = 0.04), respectively. In case of failure of either MA-AVF or D-AVF, a P-AVF was always feasible as a second native AVF hemodialysis access.
D-AVF is still the gold-standard access for hemodialysis. If D-AVF is not possible, MA-AVF should be always investigated before committing to a P-AVF.
在单一中心研究三种不同类型的自体动静脉内瘘（AVF），即远端（D：桡动脉-头静脉）、上臂中部（MA：桡动脉-头静脉）和近端（P：肱动脉-头静脉）AVF造瘘术应用于血液透析患者的效果。
对2006年至2014年在单一机构进行的一项为期8年的回顾性研究进行分析，回顾三种不同类型自体AVF造瘘术的手术效果。所有患者术前均进行双功静脉造影，以选择最佳的静脉和造瘘部位。
共纳入317例患者，其中41例为D-AVF，120例为MA-AVF，156例为P-AVF。D-AVF组中Charlson指数较低的年轻患者更为常见（p = 0.02）。MA-AVF组的平均手术时间比其他两组长15分钟（p = 0.018）。D-AVF组、MA-AVF组和P-AVF组的早期失败（30天内血栓形成）、一年通畅率、一年原发性AVF功能通畅率分别为2.4%（n = 1）、8%（n = 1）、3.8%（n = 6）（p = 0.14）；97.6%（n = 39）、99%（n = 117）、89%（n = 129）（p<0.001）；80.5%（n = 33）、75.8%（n = 91）和61.5%（n = 96）（p<0.001）。分别有17%（n = 7）、23%（n = 28）和24%（n = 38）的患者需要进行内瘘成熟的再次干预（p<0.01）。一年期静脉穿刺血肿和窃血综合征的发生率分别为9.7%（n = 4）、6.7%（n = 8）、3.8%（n = 6）（p = 0.06）；以及0%、0%和3.8%（n = 6）（p = 0.04）。如果MA-AVF或D-AVF失败，P-AVF作为第二个自体AVF血液透析通路总是可行的。
D-AVF仍然是血液透析的金标准通路。如果无法进行D-AVF，在选择P-AVF之前应始终考虑MA-AVF。
