Bender M H, Bruyninckx C M, Gerlag P G
Department of Surgery, St. Joseph Hospital, Veldhoven, The Netherlands.
J Vasc Surg. 1994 Nov;20(5):808-13. doi: 10.1016/s0741-5214(94)70168-7.
Wrist fistulas are increasingly difficult to establish in the aging hemodialysis population. We assessed fistula patency and occlusion rate in elbow fistulas compared with wrist and graft fistulas.
We analyzed all 104 fistulas created in all 68 patients who underwent hemodialysis during October 1993 at the St. Joseph General Teaching Hospital, Veldhoven, The Netherlands. Life-table patency and complications were analyzed for 31 elbow fistulas, 56 wrist fistulas, and 17 polytetrafluoroethylene or saphenous vein graft fistulas.
The patency rate for elbow fistulas was 93% at 1 year and 80% at 3 years. Wrist fistulas had a patency rate of 76% at 1 year and 65% at 3 years. Graft fistulas had a poorer patency rate: 69% at 1 year and 62% at 3 years. There were significantly more failures in the wrist fistulas (p < 0.02). Thrombosis accounted for most fistula failures. Venous stenosis was the most frequent indication for revision. The high incidence of concomitant diseases was not related to fistula outcome.
The elbow fistula performed better than the wrist fistula. Liberal use of the elbow fistula is justified, especially when the epifascial veins or the radial artery at the wrist is in poor condition. Graft fistulas should be reserved for tertiary procedures.
在老龄化血液透析人群中建立腕部动静脉内瘘日益困难。我们评估了肘部动静脉内瘘与腕部动静脉内瘘及移植血管动静脉内瘘相比的通畅率和闭塞率。
我们分析了1993年10月在荷兰韦尔德霍芬圣约瑟夫综合教学医院接受血液透析的68例患者所建立的全部104个动静脉内瘘。对31个肘部动静脉内瘘、56个腕部动静脉内瘘和17个聚四氟乙烯或大隐静脉移植血管动静脉内瘘进行了生存表通畅率及并发症分析。
肘部动静脉内瘘1年通畅率为93%，3年通畅率为80%。腕部动静脉内瘘1年通畅率为76%，3年通畅率为65%。移植血管动静脉内瘘通畅率较差：1年为69%，3年为62%。腕部动静脉内瘘失败明显更多（p<0.02）。血栓形成是大多数动静脉内瘘失败的原因。静脉狭窄是最常见的修复指征。合并症的高发生率与动静脉内瘘结局无关。
肘部动静脉内瘘的表现优于腕部动静脉内瘘。合理使用肘部动静脉内瘘是合理的，尤其是当腕部浅静脉或桡动脉状况不佳时。移植血管动静脉内瘘应留作三级手术使用。
