Zrimšek Matej, Vajdič-Trampuž Barbara, Jelenc Matija, Kšela Juš, Gubenšek Jakob
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Clin Kidney J. 2024 Nov 15;18(1):sfae360. doi: 10.1093/ckj/sfae360. eCollection 2025 Jan.
Arteriovenous fistulas (AVFs) in kidney transplant recipients are sometimes closed, either as a policy or due to complications. We collected data on the incidence of complications after AVF closure in a national cohort of transplanted patients.
Patients who received a kidney transplant between 2000 and 2015 and had a functional AVF that was later ligated or extirpated were included. Medical records were searched for arterial complications on the arm with the closed AVF. Furthermore, all patients who were still alive in January 2023 were invited for a follow-up arterial ultrasound exam.
Sixty patients were included; mean follow-up was 9.3 ± 3.8 years. There were five (8% cumulative incidence) patients with symptomatic arterial thrombosis and three (5% incidence) with a symptomatic feeding artery aneurysm. Prospective ultrasound exams were performed in 50 patients; the mean diameter of the brachial artery was almost doubled on the arm with the closed AVF (8.1 ± 3.2 versus 4.7 ± 0.7 mm; < .001). Additional asymptomatic complications were found in nine patients (18% incidence): seven cases (14% incidence) of arterial thrombosis, some extending up to the axillary artery, and three (6% incidence) brachial artery aneurysms. All patients in whom the thrombosis spread to the brachial artery had large brachial arteries (>10 mm) or an aneurysm.
We observed a high cumulative incidence of arterial thrombosis (20%) and brachial artery aneurysms (10%), sometimes developing several years after AVF closure. These complications should be taken into account when contemplating closure of a well-developed AVF and an AVF-preserving approach with flow reduction surgery might be preferred in some cases.
肾移植受者的动静脉内瘘（AVF）有时会因政策原因或并发症而闭塞。我们收集了全国范围内移植患者队列中AVF闭塞后并发症发生率的数据。
纳入2000年至2015年间接受肾移植且有功能性AVF，随后该AVF被结扎或切除的患者。检索医疗记录，查找闭塞AVF侧手臂的动脉并发症。此外，邀请了所有在2023年1月仍存活的患者进行随访动脉超声检查。
纳入60例患者；平均随访时间为9.3±3.8年。有5例（累积发生率8%）出现有症状的动脉血栓形成，3例（发生率5%）出现有症状的供血动脉动脉瘤。对50例患者进行了前瞻性超声检查；闭塞AVF侧手臂肱动脉的平均直径几乎增加了一倍（8.1±3.2对4.7±0.7mm；P<0.001）。在9例患者中发现了其他无症状并发症（发生率18%）：7例（发生率14%）动脉血栓形成，有些延伸至腋动脉，3例（发生率6%）肱动脉动脉瘤。血栓蔓延至肱动脉的所有患者均有粗大的肱动脉（>10mm）或动脉瘤。
我们观察到动脉血栓形成（20%）和肱动脉动脉瘤（10%）的累积发生率较高，有时在AVF闭塞数年后发生。在考虑闭塞发育良好的AVF时应考虑这些并发症，在某些情况下，采用保留AVF并减少血流量的手术方法可能更可取。
