Dunlop M G, Mackinlay J Y, Jenkins A M
Ann R Coll Surg Engl. 1986 Jul;68(4):203-6.
Eight years' experience with the brachiocephalic fistula for vascular access are reported. Eighty one fistulae were created in 77 patients. Forty one fistulae were created by an end to side anastomosis and 40 using a side to side technique. Overall patency was 70% at 1 year; 57% at 2 years; 50% at 3 years, which compares well with other secondary access procedures. Anastomotic configuration did not significantly affect fistula survival. Cardiac failure and arterial steal syndrome were significant problems with the side to side fistula. Two patients died from fistula complications; one exsanguinated at home from a cannulation site and another succumbed to high output cardiac failure. Infection was rare. The end to side brachiocephalic fistula is recommended as the secondary vascular access procedure of choice. It is a simple, reliable procedure which does not require graft implantation and preserves the saphenous vein, should tertiary access be required.
报告了8年使用头臂动静脉内瘘进行血管通路建立的经验。77例患者共建立了81个内瘘。41个内瘘采用端侧吻合术建立，40个采用侧侧吻合技术建立。1年时总体通畅率为70%；2年时为57%；3年时为50%，与其他二级血管通路手术相比效果良好。吻合方式对瘘的存活没有显著影响。侧侧内瘘的主要问题是心力衰竭和窃血综合征。2例患者死于内瘘并发症；1例在家中因插管部位出血过多死亡，另1例死于高输出量心力衰竭。感染罕见。推荐端侧头臂动静脉内瘘作为首选的二级血管通路手术。这是一种简单、可靠的手术，不需要植入移植物，并且在需要三级血管通路时可保留大隐静脉。
