Berkoben M, Schwab S J
ANNA J. 1995 Feb;22(1):17-24.
The morbidity and mortality of maintenance hemodialysis patients are in large part determined by the ability of the nephrologist, dialysis staff, and vascular surgeon to establish and maintain adequate vascular access. Primary arteriovenous fistulae are the preferred form of vascular access because they are the more likely to provide long-term complication-free access. In 1994, however, the majority of patients entering hemodialysis programs have vascular anatomy unsuitable for primary arteriovenous fistula creation. Synthetic fistulae are currently the more common form of vascular access. Unfortunately, this form of vascular access is more prone to thrombosis and infection. Thrombosis is the most common cause of vascular access loss. Venous stenoses account for the majority of thromboses but can be prospectively identified by performing routine measurements of venous dialysis pressure or urea recirculation. Prospective identification of venous stenoses followed by either angioplasty or surgical revision will improve fistula patency and enhance the quality of life of the hemodialysis population.
维持性血液透析患者的发病率和死亡率在很大程度上取决于肾病学家、透析工作人员和血管外科医生建立并维持充足血管通路的能力。自体动静脉内瘘是血管通路的首选形式，因为它们更有可能提供长期无并发症的通路。然而，在1994年，大多数开始接受血液透析治疗的患者其血管解剖结构不适合建立自体动静脉内瘘。目前，人工血管内瘘是更常见的血管通路形式。不幸的是，这种血管通路形式更容易发生血栓形成和感染。血栓形成是血管通路丧失的最常见原因。静脉狭窄是大多数血栓形成的原因，但可以通过常规测量静脉透析压力或尿素再循环来前瞻性地识别。对静脉狭窄进行前瞻性识别，随后进行血管成形术或手术修复，将改善内瘘通畅率并提高血液透析人群的生活质量。
