Corr Michael, Lawrie Kateřina, Baláž Peter, O'Neill Stephen
Centre of Public Health - Queen's University Belfast, Belfast, United Kingdom; Regional Nephrology & Transplant Unit-Belfast Health and Social Care Trust, Belfast, United Kingdom.
Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Transplant Rev (Orlando). 2023 Dec;37(4):100799. doi: 10.1016/j.trre.2023.100799. Epub 2023 Sep 29.
Aneurysms remain the most common complication of an arteriovenous fistula created for dialysis access. The management of an aneurysmal arteriovenous fistula (AAVF) in kidney transplant recipients remains contentious with a lack of clear clinical guidelines. Recipients of a functioning graft do not require the fistula for dialysis access, however risk of graft failure and needing the access at a future date must be considered. In this review we outline the current evidence in the assessment and management of a transplant recipient with an AAVF. We will describe our recommended five-step approach to assessing an AAVF in transplant patients; 1.) Define AAVF 2.) Risk assess AAVF 3.) Assess transplant graft function and future graft failure risk 4.) Consider future renal replacement therapy options 5.) Vascular mapping to assess future vascular access options. Then we will describe the current therapeutic options and when they would most appropriately be employed.
动脉瘤仍然是为透析通路而建立的动静脉内瘘最常见的并发症。肾移植受者的动脉瘤性动静脉内瘘（AAVF）的管理仍存在争议，缺乏明确的临床指南。有功能移植物的受者不需要动静脉内瘘进行透析通路，但必须考虑移植物失败的风险以及未来需要该通路的可能性。在本综述中，我们概述了目前关于评估和管理患有AAVF的移植受者的证据。我们将描述我们推荐的评估移植患者AAVF的五步方法；1.）定义AAVF 2.）对AAVF进行风险评估 3.）评估移植移植物功能和未来移植物失败风险 4.）考虑未来的肾脏替代治疗选择 5.）进行血管造影以评估未来的血管通路选择。然后我们将描述目前的治疗选择以及何时最适合采用这些选择。
