Lin Yen-Chin, Huang Yu-Ying, Lin Ming-Yen, Chiu Yi-Wen, Lim Lee-Moay, Hsieh Chong-Chao
1 Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.
2 Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.
J Vasc Access. 2019 Sep;20(5):557-562. doi: 10.1177/1129729818820184. Epub 2019 Jan 24.
Arteriovenous fistula is recommended for the general dialysis population, but its use remains controversial in the elderly population. We evaluated the long-term outcomes of lateral tunneled transposed brachiobasilic arteriovenous fistulas in older patients who underwent hemodialysis.
In this retrospective cohort study, we included patients who received a two-stage transposed brachiobasilic arteriovenous fistula in a medical center from May 2005 to January 2014. The patients were followed up from the fistula placement date until any intervention, death, failure, January 2015, or the end of the sixth year. Death and arteriovenous fistula failure during the observation period were considered as adverse outcomes, and the cause of death was identified. The cumulative patency rate was calculated using the Kaplan-Meier approach to reveal the long-term outcomes of this procedure.
Among the 66 patients who underwent surgery, the average age was 65.8 ± 13.5 years and the majority were females (62.1%). After a median follow-up of 20.6 months, 19 patients died, 12 (18.2%) received vascular intervention, and 3 experienced fistula failure. No significant difference was observed in the 6-year cumulative patency rates between younger and older adults (96.3% vs 80.3%, p = 0.58). None of the deaths during the observation period were related to bloodstream infection.
A two-stage lateral tunneled transposed brachiobasilic arteriovenous fistula can be applied to patients undergoing hemodialysis, regardless of age.
动静脉内瘘推荐用于一般透析人群，但在老年人群中的应用仍存在争议。我们评估了接受血液透析的老年患者行侧隧道转位肱桡动脉动静脉内瘘的长期结局。
在这项回顾性队列研究中，我们纳入了2005年5月至2014年1月在一家医疗中心接受两阶段转位肱桡动脉动静脉内瘘手术的患者。从内瘘置入日期开始对患者进行随访，直至任何干预、死亡、内瘘失功、2015年1月或第六年结束。观察期内的死亡和动静脉内瘘失功被视为不良结局，并确定死亡原因。采用Kaplan-Meier方法计算累积通畅率，以揭示该手术的长期结局。
在接受手术的66例患者中，平均年龄为65.8±13.5岁，大多数为女性（62.1%）。中位随访20.6个月后，19例患者死亡，12例（18.2%）接受了血管干预，3例发生内瘘失功。年轻人和老年人的6年累积通畅率无显著差异（96.3%对80.3%，p = 0.58）。观察期内的死亡均与血流感染无关。
两阶段侧隧道转位肱桡动脉动静脉内瘘可应用于接受血液透析的患者，无论年龄大小。
