Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
Ann Vasc Surg. 2021 Jan;70:568.e13-568.e17. doi: 10.1016/j.avsg.2020.08.120. Epub 2020 Sep 2.
Renal dysfunction, requiring renal replacement therapy (RRT) is commonly encountered in patients with left ventricular assist devices (LVADs). Continuous flow LVAD (CFLVAD) is the most widely used device. Nonpulsatile blood flow begets special hemodynamic changes. This poses a unique challenge in choosing a long-term dialysis access for patients with CFLVAD where life expectancy is limited.
A 61-year-old man with an implanted CFLVAD and renal dysfunction receiving intermittent RRT through a nontunneled dialysis catheter had progressed to dialysis-dependent renal failure. He was referred to us for a permanent hemodialysis access.
The patient underwent a right brachio-brachial arterio-venous graft (AVG) placement. The graft was successfully cannulated for hemodialysis on postoperative day 15. On regular follow-up at 18 months, the graft was still functional.
Dialysis access for patients on LVAD is an exceptional management problem owing to both altered physiology and guarded overall prognosis. We recommend the use of AVG as a convenient and durable option-facilitating early cannulation and expediting freedom from indwelling catheters that may lead to catastrophic consequences. This should limit the need for secondary interventions, hospitalization, and cost, thus improving quality of life.
左心室辅助装置（LVAD）患者常出现肾功能障碍，需要肾脏替代治疗（RRT）。连续流 LVAD（CFLVAD）是最广泛使用的装置。非脉动血流会产生特殊的血液动力学变化。这在为预期寿命有限的 CFLVAD 患者选择长期透析通路时带来了独特的挑战。
一名 61 岁男性，植入 CFLVAD 后出现肾功能障碍，通过非隧道透析导管间歇性接受 RRT。他因需要永久性血液透析通路而被转介给我们。
患者接受了右肱-肱动脉动静脉移植物（AVG）放置术。术后第 15 天，移植物成功进行了血液透析穿刺。在 18 个月的定期随访中，移植物仍保持功能。
由于改变了生理学和预后较差，LVAD 患者的透析通路是一个特殊的管理问题。我们建议使用 AVG 作为一种方便且耐用的选择，便于早期穿刺，并避免留置导管可能导致的灾难性后果。这将减少二次干预、住院和费用的需求，从而提高生活质量。
