Sterling W A
Surg Gynecol Obstet. 1979 Aug;149(2):252-4.
A new vascular access procedure consists of attaching an arteriovenous shunt to a subcutaneous arteriovenous fistula. The procedure was designed for patients who need immediate as well as long term hemodialysis and in whom the Brescia-Cimino type of fistula could not be done. Secondary objectives for this new procedure were a prolonged patency interval and a lower complication rate of arteriovenous fistulas. Six patients underwent this procedure and were observed from two to five months. Five shunts remained patent for a minimum of two weeks. Five patients have presently functioning fistulas, and in three of these, both shunts and fistulas remain patent. Two of the presently functioning shunts required declotting. Two shunts were removed when neither declotting nor revision was possible, and one shunt was removed because of infection. One fistula was lost due to a technical error, and two of the five presently functioning fistulas have required declotting. We believe clotting was due chiefly to the fact that patients selected for this procedure were from the group who had multiple previous clotting episodes and vascular access procedures. It remains to be seen whether or not more careful patient selection will accomplish the secondary objectives.
一种新的血管通路手术包括将动静脉分流器连接到皮下动静脉瘘。该手术是为那些既需要立即进行又需要长期血液透析且无法进行布雷西亚 - 奇米诺（Brescia - Cimino）式瘘管手术的患者设计的。此新手术的次要目标是延长通畅间隔时间并降低动静脉瘘的并发症发生率。六名患者接受了该手术，并观察了两到五个月。五个分流器至少保持通畅两周。五名患者目前拥有功能正常的瘘管，其中三名患者的分流器和瘘管均保持通畅。目前有两个正在发挥作用的分流器需要清除血栓。当既无法清除血栓也无法进行修复时，移除了两个分流器，还有一个分流器因感染而被移除。一个瘘管因技术失误而失败，目前五个功能正常的瘘管中有两个需要清除血栓。我们认为血栓形成主要是因为选择接受该手术的患者来自之前有多次血栓形成发作和血管通路手术史的群体。更谨慎地选择患者是否能实现次要目标还有待观察。
