Department of Nephrology and Hypertension, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Department of Nephrology and Hypertension, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Am J Kidney Dis. 2021 Jul;78(1):116-124. doi: 10.1053/j.ajkd.2020.11.027. Epub 2021 May 6.
In the United States, hemodialysis remains the most common treatment modality for kidney failure, chosen by almost 90% of incident patients. A functioning vascular access is key to providing adequate hemodialysis therapy. Recently, major innovations in devices and technology for hemodialysis vascular access care have rapidly changed the landscape. Novel endovascular devices for creation of arteriovenous fistulas may offer a solution to the barriers encountered in initiating maintenance hemodialysis with a permanent vascular access rather than a central venous catheter (CVC). Furthermore, in the prevalent hemodialysis population, the minimally invasive endovascular arteriovenous fistula procedure should help improve long wait times for vascular access creation, which remains a major barrier to reducing CVC dependence. Bioengineered grafts are being developed and may offer another option to polytetrafluoroethylene grafts. Early studies with these biocompatible grafts are promising, as additional studies continue to evaluate their clinical outcomes in comparison to cryopreserved or synthetic options. Prolonging the vascular access patency with appropriate use of devices such as drug-coated balloons and stent grafts may complement the novel techniques of creating arteriovenous access. Finally, innovative solutions to treat stenosed and occluded thoracic central veins can provide an approach to creating a vascular access and allow patients with exhausted vasculature to remain on hemodialysis. The robust developments in hemodialysis vascular access are likely to change practice patterns in the near future.
在美国，血液透析仍然是肾衰竭最常见的治疗方式，几乎 90%的新发病例患者选择这种方式。功能正常的血管通路是提供充分血液透析治疗的关键。最近，血液透析血管通路护理设备和技术的重大创新迅速改变了这一领域的格局。用于创建动静脉瘘的新型腔内设备可能为解决在使用永久性血管通路而不是中心静脉导管（CVC）开始维持性血液透析时遇到的障碍提供了一种解决方案。此外，在普遍的血液透析人群中，微创腔内动静脉瘘手术应该有助于缩短血管通路创建的漫长等待时间，这仍然是减少对 CVC 依赖的主要障碍。正在开发生物工程移植物，它可能是聚四氟乙烯移植物的另一种选择。随着对这些生物相容性移植物的进一步研究，评估它们与冷冻或合成移植物相比的临床结果，早期研究结果很有前景。适当使用药物涂层球囊和支架移植物等设备来延长血管通路通畅性，可以补充创建动静脉通路的新技术。最后，治疗狭窄和闭塞性胸内中心静脉的创新解决方案可以为建立血管通路提供一种方法，使血管耗尽的患者能够继续接受血液透析。血液透析血管通路的大量发展可能会在不久的将来改变实践模式。
