Department of Surgery, University of Arizona, Tucson, AZ.
Pima Heart and Vascular, Tucson, AZ.
Ann Vasc Surg. 2021 Jan;70:131-136. doi: 10.1016/j.avsg.2020.07.009. Epub 2020 Jul 29.
In this study, we compared the outcomes of forearm arteriovenous grafts (AVGs) and upper arm AVGs in a large, prospectively collected data set, which represents real-world experience with upper extremity prosthetic dialysis access, to determine if there are clinically significant differences in the upper arm and forearm positions.
We identified 2,063 patients who received upper extremity AVGs within the Vascular Quality Initiative data set (2010-2018). Axillary to axillary upper arm AVGs were excluded (n = 394) from the analysis. The main outcome measures were primary and secondary patency rates at 12 months. Other outcomes were 6-month wound infection, steal syndrome, and arm swelling. The log-rank test was used to evaluate patency loss using a Kaplan-Meier analysis. Cox proportional hazards models were used to examine adjusted association between locations (forearm and upper arm) and outcomes.
There were 1,160 forearm AVGs and 509 upper arm brachial artery AVGs in the study cohort. Patients with forearm AVGs were more likely to have a body mass index > 30 (45% vs. 38%, P = 0.013), no history of previous access (73% vs. 63%, P < 0.001), and underwent local-regional anesthesia (56% vs. 43%, P < 0.001). The 12-month primary patency (51.5% vs. 62.9%, P < 0.001) and secondary patency (76.4% vs. 89.1%, P < 0.001) were significantly lower for forearm AVGs. Wound infection, steal syndrome, and arm swelling were similar between forearm AVGs and upper arm AVGs at the 6-month follow-up. In multivariable analysis, the primary patency loss (adjusted hazard ratio (aHR) 1.66, 95% confidence interval (CI) 1.33-2.01, P < 0.001) and 12-month secondary patency loss (aHR 2.71, 95% CI 1.84-3.98, P < 0.001) were significantly higher for forearm AVGs at 12 months.
From this observational study of the Vascular Quality Initiative data set, the primary and secondary patency rates were superior for upper arm brachial artery AVGs compared with forearm AVGs.
本研究通过对比大型前瞻性采集数据集（代表了上肢人造动静脉透析通路的真实世界经验）中前臂动静脉移植物（AVG）和上臂 AVG 的结果，来确定在上臂和前臂位置是否存在具有临床意义的差异。
我们在血管质量倡议数据集中确定了 2063 名接受上肢 AVG 的患者（2010-2018 年）。分析中排除了腋动脉至腋动脉的上臂 AVG（n=394）。主要观察指标为 12 个月时的一级和二级通畅率。其他结果包括 6 个月时的伤口感染、窃血综合征和手臂肿胀。采用对数秩检验结合 Kaplan-Meier 分析评估通畅性丧失。采用 Cox 比例风险模型检验位置（前臂和上臂）与结果之间的调整关联。
研究队列中有 1160 例前臂 AVG 和 509 例上臂肱动脉 AVG。前臂 AVG 患者更有可能体质量指数＞30（45%比 38%，P=0.013）、无既往通路史（73%比 63%，P＜0.001）和接受局部区域麻醉（56%比 43%，P＜0.001）。前臂 AVG 的 12 个月一级通畅率（51.5%比 62.9%，P＜0.001）和二级通畅率（76.4%比 89.1%，P＜0.001）显著较低。在 6 个月随访时，前臂 AVG 和上臂 AVG 的伤口感染、窃血综合征和手臂肿胀相似。多变量分析显示，前臂 AVG 的 12 个月一级通畅率损失（调整后的危险比（aHR）1.66，95%置信区间（CI）1.33-2.01，P＜0.001）和 12 个月二级通畅率损失（aHR 2.71，95%CI 1.84-3.98，P＜0.001）显著更高。
本研究通过观察血管质量倡议数据集，结果显示与前臂 AVG 相比，上臂肱动脉 AVG 的一级和二级通畅率更高。
