Salem Karim M, Abou Ali Adham N, Sue Erika, Mohapatra Abhisekh, Eid Raymond E, Kormos Robert L, Chaer Rabih A, Avgerinos Efthymios D
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
J Vasc Access. 2020 Mar;21(2):176-179. doi: 10.1177/1129729819865706. Epub 2019 Jul 31.
Postoperative renal dysfunction necessitating hemodialysis after implantation of ventricular assist devices presents a challenge with respect to establishment of hemodialysis access. Lack of pulsatile flow has led to concerns that arteriovenous fistulas will not mature. This study aims to evaluate arteriovenous fistula as a method of hemodialysis.
Consecutive patients who underwent implantation of a ventricular assist device between 1988 and 2016 with a subsequent need for hemodialysis were identified. Retrospective data were collected for patients requiring hemodialysis through an arteriovenous fistula or arteriovenous graft. Access flow rates and duration of patency are reported.
Sixty-four patients were identified (10 required long-term hemodialysis, 5 via arteriovenous fistula, 1 via arteriovenous graft). All six patients receiving long-term hemodialysis access were on continuous-flow ventricular assist devices. Brachiocephalic arteriovenous fistulas were performed in all arteriovenous fistula patients, and the average preoperative vein diameter was 4.1 ± 0.9 mm. On 30-day follow-up, the average flow rate was 1262 ± 643 mL/min (880-2220). In arteriovenous fistula patients, one died at 30 days, one arteriovenous fistula required ligation for steal syndrome at 5 months, and one was abandoned after 10.7 months for low flow. Of remaining fistulas, one was converted to an arteriovenous graft at 1.7 years for malfunction (with 5.3 month patency), and one remains open at 4.0 years.
Arteriovenous fistulas should be considered in selected patients with ventricular assist devices as a means of long-term hemodialysis access to avoid use of catheters. Maturation and usage of primary arteriovenous fistulas is possible despite lack of pulsatile flow.
心室辅助装置植入术后出现需要血液透析的肾功能不全，在建立血液透析通路方面构成挑战。缺乏搏动血流引发了对动静脉内瘘无法成熟的担忧。本研究旨在评估动静脉内瘘作为一种血液透析方法的情况。
确定1988年至2016年间接受心室辅助装置植入且随后需要血液透析的连续患者。收集通过动静脉内瘘或动静脉移植物进行血液透析的患者的回顾性数据。报告通路血流量和通畅持续时间。
共确定64例患者（10例需要长期血液透析，5例通过动静脉内瘘，1例通过动静脉移植物）。所有6例接受长期血液透析通路的患者均使用连续流心室辅助装置。所有动静脉内瘘患者均进行了头臂动静脉内瘘手术，术前静脉平均直径为4.1±0.9毫米。在30天随访时，平均血流量为1262±643毫升/分钟（880 - 2220）。在动静脉内瘘患者中，1例在30天时死亡，1例动静脉内瘘在5个月时因窃血综合征需要结扎，1例在10.7个月后因血流量低而放弃。其余内瘘中，1例在1.7年时因功能障碍转换为动静脉移植物（通畅5.3个月），1例在4.0年时仍保持通畅。
对于选定的心室辅助装置患者，应考虑将动静脉内瘘作为长期血液透析通路的一种手段，以避免使用导管。尽管缺乏搏动血流，原发性动静脉内瘘仍有可能成熟并使用。
