Division of Nephrology, Salisbury VA Health Care System, Salisbury, North Carolina, USA.
Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Kidney Int. 2018 Apr;93(4):797-802. doi: 10.1016/j.kint.2017.10.030. Epub 2018 Feb 21.
Exhausted vasculature is not uncommon in patients receiving long-term hemodialysis treatment. Certain patients exhaust their peripheral veins and do not retain the venous capital necessary for fistula creation. Others suffer from severe peripheral arterial disease and despite the presence of adequate venous capital are not able to receive an arteriovenous access successfully. Most importantly, in the case of occluded central veins, the creation of an arteriovenous access in the arms or thighs would be futile, even if peripheral veins and/or arteries were available. Because renal transplant is not readily available, such patients virtually face death in the absence of dialysis therapy. Hence, it is critically important that vascular access options be available to successfully receive renal replacement therapy. This article describes accesses of last resort and provides information vital to nephrologists for discussion with their patients and to surgeons in choosing an optimal option.
长期接受血液透析治疗的患者中，血管耗竭并不罕见。某些患者外周静脉耗竭，无法保留造瘘所需的静脉资本。还有一些患者患有严重的外周动脉疾病，尽管存在足够的静脉资本，但无法成功接受动静脉通路。最重要的是，在中心静脉阻塞的情况下，即使外周静脉和/或动脉可用，在手臂或大腿上建立动静脉通路也将是徒劳的。由于肾移植不易获得，因此这些患者如果没有透析治疗，实际上就面临死亡。因此，成功接受肾脏替代治疗的血管通路选择至关重要。本文介绍了最后的选择，并为肾病学家提供了与患者讨论和为外科医生选择最佳选择的重要信息。
