Keoghane S R, Leow C K, Gray D W
Nuffield Department of Surgery, Oxford Transplant Centre, Churchill Hospital, UK.
Nephrol Dial Transplant. 1993;8(2):154-6.
For long-term haemodialysis to be successful an adequate length of vessel with correspondingly high flow is necessary, and the use of a peripheral arteriovenous fistula (AVF) between brachial artery and median cephalic vein is well described for long-term vascular access. However, the length of vessel available is often insufficient for dialysis and the time-lag between formation and availability for use may be prolonged. Primary insertion of a PTFE interposition graft is an alternative but may be technically difficult due to the small diameter of vein available for run-off, resulting in a significant rate of thrombosis. We advocate early AVF formation in most patients, even where the fistula is unlikely to prove usable for dialysis, with the express purpose of dilating the veins prior to PTFE graft insertion. The time-lag between AVF formation and PTFE graft insertion may be as short as 1 week. Although conversion of a functioning AVF to PTFE interposition graft has been described by others, we believe the routine use of AVF formation prior to PTFE insertion has not been previously advocated and gives a considerable advantage in patients with difficult dialysis access.
为使长期血液透析取得成功，需要有足够长度且血流量相应较高的血管，并且对于长期血管通路而言，使用肱动脉与头正中静脉之间的外周动静脉内瘘（AVF）已有详尽描述。然而，可用血管的长度往往不足以进行透析，且从形成到可供使用的时间间隔可能会延长。一期插入聚四氟乙烯（PTFE）移植血管是一种替代方法，但由于可供回流的静脉直径较小，技术上可能存在困难，导致血栓形成率较高。我们主张在大多数患者中尽早形成AVF，即使该内瘘不太可能用于透析，其明确目的是在插入PTFE移植血管之前扩张静脉。AVF形成与PTFE移植血管插入之间的时间间隔可短至1周。尽管其他人已描述了将功能性AVF转换为PTFE移植血管的方法，但我们认为，在插入PTFE之前常规使用AVF形成方法此前尚未被提倡，而这对于透析通路困难的患者具有相当大的优势。
