Korn Abraham, Alipour Hamid, Zane Joshua, Shahverdiani Ali, Ryan Timothy J, Kaji Amy, Bowens Nina, de Virgilio Christian
Department of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA.
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA.
Ann Vasc Surg. 2018 May;49:281-284. doi: 10.1016/j.avsg.2018.02.003. Epub 2018 Feb 23.
Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence and identify factors associated with early thrombosis of AVF and to determine salvage rates following thrombosis, at a high-volume hemodialysis access center.
Retrospective review of autologous AVF was created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery.
There were 291 AVFs. The median age was 54.7 years, and 192 patients (66%) were male. Early postoperative AVF thrombosis was noted in 5 (1.7%) cases. Factors associated with early thrombosis on univariate analysis included previous access surgery (P = 0.02) and absence of a good intraoperative thrill (P = 0.006). Intraoperative protamine use trended toward significance (P = 0.06). Factors that were not significant included gender, diabetes, dialysis at time of surgery, fistula configuration, and systemic heparin use. None of the thrombosed fistulas were salvaged.
Early thrombosis is a relatively rare complication of AVF creation at a high-volume center. Previous access surgery and absence of good thrill at conclusion of the procedure are associated with early thrombosis.
动静脉内瘘（AVF）是血液透析通路的首选方式。早期血栓形成会阻碍功能性AVF的建立。我们试图在一家大型血液透析通路中心确定AVF早期血栓形成的发生率，识别与之相关的因素，并确定血栓形成后的挽救率。
回顾性分析2014年11月至2016年7月在单一中心建立的自体AVF。早期血栓形成定义为手术后30天内发生的血栓形成。
共291例AVF。中位年龄为54.7岁，192例患者（66%）为男性。5例（1.7%）出现术后早期AVF血栓形成。单因素分析中与早期血栓形成相关的因素包括既往血管通路手术史（P = 0.02）和术中未触及良好震颤（P = 0.006）。术中使用鱼精蛋白有显著趋势（P = 0.06）。无显著意义的因素包括性别、糖尿病、手术时的透析情况、内瘘构型和全身肝素使用情况。所有血栓形成的内瘘均未挽救成功。
在大型中心，早期血栓形成是AVF建立相对少见的并发症。既往血管通路手术史和手术结束时未触及良好震颤与早期血栓形成有关。
