Lee Ja Young, Kim Young Ok
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Intern Med. 2017 Sep;32(5):790-797. doi: 10.3904/kjim.2017.268. Epub 2017 Aug 22.
The radiocephalic arteriovenous fistula (AVF) provides optimal vascular access for hemodialysis; it has a higher long-term patency rate and fewer complications than other vascular access methods. However, the AVF has a high primary failure rate. The presence of small-diameter vessels at anastomosis sites is an important risk factor for AVF failure. However, in a recent study, despite selecting an adequate artery and vein for creating an AVF by routine preoperative vascular mapping, AVF maturation and primary failure occurred. Thus, pre-existing arteriosclerosis at AVF anastomosis sites likely contributes to AVF failure. In this review, we discuss the relationship between pathologic changes and AVF patency in hemodialysis patients. Because arteriosclerosis of the major arteries such as the coronary and carotid arteries is associated with cardiovascular mortality, we also review the impact of arteriosclerosis of upper arm arteries at AVF anastomosis sites on cardiovascular mortality in hemodialysis patients.
桡动脉-头静脉动静脉内瘘（AVF）为血液透析提供了最佳的血管通路；与其他血管通路方法相比，它具有更高的长期通畅率和更少的并发症。然而，AVF的初次失败率很高。吻合部位存在小直径血管是AVF失败的一个重要危险因素。然而，在最近的一项研究中，尽管通过常规术前血管造影选择了合适的动脉和静脉来建立AVF，但仍发生了AVF成熟和初次失败的情况。因此，AVF吻合部位预先存在的动脉硬化可能导致AVF失败。在这篇综述中，我们讨论了血液透析患者病理变化与AVF通畅性之间的关系。由于冠状动脉和颈动脉等主要动脉的动脉硬化与心血管死亡率相关，我们还综述了AVF吻合部位上臂动脉的动脉硬化对血液透析患者心血管死亡率的影响。
