Gorski T F, Nguyen H Q, Gorski Y C, Chung H J, Jamal A, Muney J
Department of Surgery, Brooklyn Hospital Center, New York, USA.
Am Surg. 1998 Apr;64(4):338-40.
Arteriovenous access for long-term hemodialysis in patients with the acquired immunodeficiency syndrome (AIDS) represents a special challenge. Many of these patients are chronic intravenous drug abusers and do not have patent superficial upper-extremity veins available for conventional arteriovenous fistulas. This group of patients is also particularly prone to infections, which contraindicates the use of prosthetic grafts. Over a period of 13 months, five lower-extremity saphenous vein transposition arteriovenous fistulas (SVTAFs) were performed. Four patients had a diagnosis of AIDS at the time of operation; all of these were intravenous drug abusers. Three patients were male, two were female, and their age ranged from 34 to 66 years (mean, 48). Three patients had a SVTAF as their first hemodialysis access, and in two it was performed after multiple failed upper-extremity accesses. Four fistulas remain patent to date, after a mean follow-up of 11 months (range, 4 weeks to 16 months). One fistula thrombosed 4 weeks postoperatively, due to a hematoma that occurred after premature venipuncture for dialysis. There were no other major complications. We conclude that SVTAF is a suitable alternative to the limited hemodialysis venous access sites, especially in the AIDS population.
为获得性免疫缺陷综合征（艾滋病）患者建立长期血液透析的动静脉通路是一项特殊挑战。这些患者中有许多是慢性静脉药物滥用者，没有可用于传统动静脉内瘘的上肢浅表可用静脉。这组患者也特别容易感染，这使得人工血管移植物的使用成为禁忌。在13个月的时间里，共进行了5例下肢大隐静脉转位动静脉内瘘（SVTAF）手术。4例患者在手术时被诊断为艾滋病；所有这些患者都是静脉药物滥用者。3例为男性，2例为女性，年龄在34至66岁之间（平均48岁）。3例患者将SVTAF作为首次血液透析通路，2例患者是在上肢通路多次失败后进行的该手术。平均随访11个月（范围4周至16个月）后，4例内瘘至今仍保持通畅。1例内瘘在术后4周因过早进行透析静脉穿刺导致血肿而血栓形成。无其他严重并发症。我们得出结论，SVTAF是有限的血液透析静脉通路部位的合适替代方案，尤其是在艾滋病患者群体中。
