SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Bristol Medical School, University of Bristol, Bristol, United Kingdom.
SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
J Vasc Surg. 2021 Jul;74(1):327-333.e2. doi: 10.1016/j.jvs.2020.12.106. Epub 2021 Feb 4.
Creation of good long-term arteriovenous access is essential in patients requiring hemodialysis for end-stage renal failure. However, arteriovenous grafts or fistulae can be complicated by infection that may require emergency surgery. For infections that involve the brachial artery anastomosis, or if total graft explantation is indicated, brachial artery repair or reconstruction is often required. An alternative management strategy would be brachial artery ligation (BAL). We performed a systematic review to evaluate the outcomes of BAL that has been performed for infected arteriovenous grafts or fistulae.
A thorough literature search was conducted using various electronic databases. We included articles that reported outcomes of BAL performed for infected arteriovenous grafts or fistulae. The primary outcome was the incidence of upper limb ischemia after BAL. Secondary outcomes were the need for urgent revascularization, need for upper limb amputation, and incidence of postoperative neurological deficit after BAL.
A total of five studies with a total of 125 patients were included in our systematic review. BAL was performed for infected arteriovenous grafts or fistulae for all studies. Follow-up period ranged from 1 to 27 months. The incidence of upper limb ischemia after BAL was low. Only a single study reported three patients who developed upper limb ischemia. Two patients required urgent revascularization, and one patient required forearm amputation after proximal ligation. All studies reported clearance of infection with no recurrence.
Distal BAL may be performed safely for patients with infected arteriovenous fistulae or grafts with low risk of upper limb ischemia, postoperative neurological deficit, and recurrent infection.
为终末期肾衰竭需要血液透析的患者创建良好的长期动静脉通路是至关重要的。然而，动静脉移植物或瘘管可能会因感染而复杂化，这可能需要紧急手术。对于涉及肱动脉吻合口的感染，或者如果需要完全移植物切除，则通常需要进行肱动脉修复或重建。另一种治疗策略是肱动脉结扎（BAL）。我们进行了系统评价，以评估因感染的动静脉移植物或瘘管而行 BAL 的结果。
我们使用各种电子数据库进行了彻底的文献搜索。我们纳入了报道因感染的动静脉移植物或瘘管而行 BAL 的结果的文章。主要结局是 BAL 后上肢缺血的发生率。次要结局是紧急血运重建的需要、上肢截肢的需要以及 BAL 后术后神经功能缺损的发生率。
我们的系统评价共纳入了 5 项研究，共 125 例患者。所有研究均因感染的动静脉移植物或瘘管而行 BAL。随访时间从 1 到 27 个月不等。BAL 后上肢缺血的发生率较低。只有一项研究报告了 3 例上肢缺血的患者。2 例患者需要紧急血运重建，1 例患者在近端结扎后需要前臂截肢。所有研究均报告感染清除，无复发。
对于感染的动静脉瘘或移植物患者，远端 BAL 可能是安全的，其上肢缺血、术后神经功能缺损和感染复发的风险较低。
