Doherty Daniel J, Pottle Alison, Malietzis George, Hakim Nadey, Barbir Mahmoud, Crane Jeremy S
1 Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Hammersmith Hospital, London - UK.
2 Royal Brompton & Harefield NHS Foundation Trust, Lipoprotein-Apheresis Unit, Cardiology Department, Harefield Hospital, Harefield, Middlesex - UK.
J Vasc Access. 2018 Jan;19(1):52-57. doi: 10.5301/jva.5000755.
Lipoprotein apheresis (LA) has proven to be an effective, safe and life-saving therapy. Vascular access is needed to facilitate this treatment but has recognised complications. Despite consistency in treatment indication and duration there are no guidelines in place. The aim of this study is to characterise vascular access practice at the UK's largest LA centre and forward suggestions for future approaches.
A retrospective analysis of vascular access strategies was undertaken in all patients who received LA treatment in the low-density lipoprotein (LDL) Apheresis Unit at Harefield Hospital (Middlesex, UK) from November 2000 to March 2016.
Fifty-three former and current patients underwent 4260 LA treatments. Peripheral vein cannulation represented 79% of initial vascular access strategies with arteriovenous (AV) fistula use accounting for 15%. Last used method of vascular access was peripheral vein cannulation in 57% versus AV fistula in 32%. Total AV fistula failure rate was 37%.
Peripheral vein cannulation remains the most common method to facilitate LA. Practice trends indicate a move towards AV fistula creation; the favoured approach receiving support from the expert body in this area. AV fistula failure rate is high and of great concern, therefore we suggest the implementation of upper limb ultrasound vascular mapping in all patients who meet treatment eligibility criteria. We encourage close ties between apheresis units and specialist surgical centres to facilitate patient counselling and monitoring. Further prospective data regarding fistula failure is needed in this expanding treatment field.
脂蛋白分离术（LA）已被证明是一种有效、安全且能挽救生命的治疗方法。进行这种治疗需要血管通路，但存在公认的并发症。尽管在治疗指征和持续时间上保持一致，但目前尚无相关指南。本研究的目的是描述英国最大的脂蛋白分离术中心的血管通路实践情况，并对未来的方法提出建议。
对2000年11月至2016年3月期间在英国米德尔塞克斯郡哈雷菲尔德医院低密度脂蛋白（LDL）分离术单元接受脂蛋白分离术治疗的所有患者的血管通路策略进行回顾性分析。
53名既往和当前患者接受了4260次脂蛋白分离术治疗。外周静脉插管占初始血管通路策略的79%，动静脉（AV）内瘘的使用占15%。最后使用的血管通路方法中，外周静脉插管占57%，AV内瘘占32%。AV内瘘的总失败率为37%。
外周静脉插管仍然是促进脂蛋白分离术的最常见方法。实践趋势表明正朝着建立AV内瘘的方向发展；这一首选方法得到了该领域专家机构的支持。AV内瘘失败率很高且令人高度关注，因此我们建议对所有符合治疗资格标准的患者实施上肢超声血管造影。我们鼓励分离术单元与专业外科中心密切合作，以方便患者咨询和监测。在这个不断扩大的治疗领域，需要关于内瘘失败的进一步前瞻性数据。
