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长期血液透析动静脉血管通路的非血栓性并发症

Authors
Mark Little, FRCP, PhD
Karen Woo, MD
Section Editors
Steve J Schwab, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
王艳秋, 副主任医师，副教授

引言

血液透析动静脉血管通路失功是维持性血液透析中的一个重要问题，可能也是多种并发症的最终结果。最常见的并发症为瘘管或移植物内血栓形成，这将在别处讨论；但也会发生血清肿、肢体肿胀、动脉瘤/假性动脉瘤形成、神经病变、肢体缺血、心力衰竭及感染等并发症。这些并发症总结在此。

长期血液透析动静脉血管通路的血栓性并发症将在别处讨论。 (参见“血液透析动静脉移植物和动静脉瘘狭窄及血栓形成性并发症的治疗概述”)

上肢通路和下肢通路

不管是应用的是自体内瘘还是人工血管通路，下肢长期血液透析通路的并发症都与上肢相似。然而文献几乎只针对采用上肢动静脉通路的患者评估并发症，这主要是因为下肢通路使用较少，其仅用于上肢通路耗竭的患者[1-3]。上肢和下肢间并发症的重要差异包括下列内容[4]。

●下肢更常发生外周血管阻塞性疾病。尽管症状性窃血可能对上肢和下肢具有同等影响，但上肢需要截肢的情况不常见，而下肢组织缺损和大截肢术常作为下肢血液透析血管通路并发症出现。

●下肢通路距下消化道较近，可能会使通路更易发生感染性并发症。体型也会影响通路区域维持适当基本卫生状态的能力。

         

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-06.
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References
Top
  1. Korzets A, Ori Y, Baytner S, et al. The femoral artery-femoral vein polytetrafluoroethylene graft: a 14-year retrospective study. Nephrol Dial Transplant 1998; 13:1215.
  2. Vogel KM, Martino MA, O'Brien SP, Kerstein MD. Complications of lower extremity arteriovenous grafts in patients with end-stage renal disease. South Med J 2000; 93:593.
  3. Geenen IL, Nyilas L, Stephen MS, et al. Prosthetic lower extremity hemodialysis access grafts have satisfactory patency despite a high incidence of infection. J Vasc Surg 2010; 52:1546.
  4. Carsten CG 3rd. Lower extremity arteriovenous hemodialysis access: an important adjunct in select patients. Semin Vasc Surg 2011; 24:102.
  5. Dauria DM, Dyk P, Garvin P. Incidence and management of seroma after arteriovenous graft placement. J Am Coll Surg 2006; 203:506.
  6. Eid A, Lyass S. Acute perigraft seroma simulating anastomotic bleeding of a PTFE graft applied as an arteriovenous shunt for hemodialysis. Ann Vasc Surg 1996; 10:290.
  7. Chen JC, Kamal DM, Jastrzebski J, Taylor DC. Venovenostomy for outflow venous obstruction in patients with upper extremity autogenous hemodialysis arteriovenous access. Ann Vasc Surg 2005; 19:629.
  8. Woo K, Cook PR, Garg J, et al. Midterm results of a novel technique to salvage autogenous dialysis access in aneurysmal arteriovenous fistulas. J Vasc Surg 2010; 51:921.
  9. Pasklinsky G, Meisner RJ, Labropoulos N, et al. Management of true aneurysms of hemodialysis access fistulas. J Vasc Surg 2011; 53:1291.
  10. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48 Suppl 1:S2.
  11. NKF-DOQI Clinical Practice Guidelines for Vascular Access. V. Management of complications: Optimal approaches for treating complications. Am J Kidney Dis 2001; 37(Suppl 1):S163.
  12. Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17:S1.
  13. Witz M, Werner M, Bernheim J, et al. Ultrasound-guided compression repair of pseudoaneurysms complicating a forearm dialysis arteriovenous fistula. Nephrol Dial Transplant 2000; 15:1453.
  14. Clark TW, Abraham RJ. Thrombin injection for treatment of brachial artery pseudoaneurysm at the site of a hemodialysis fistula: report of two patients. Cardiovasc Intervent Radiol 2000; 23:396.
  15. Palder SB, Kirkman RL, Whittemore AD, et al. Vascular access for hemodialysis. Patency rates and results of revision. Ann Surg 1985; 202:235.
  16. Miles AM. Vascular steal syndrome and ischaemic monomelic neuropathy: two variants of upper limb ischaemia after haemodialysis vascular access surgery. Nephrol Dial Transplant 1999; 14:297.
  17. Gilbert MS, Robinson A, Baez A, et al. Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis. J Bone Joint Surg Am 1988; 70:1145.
  18. Reyal Y, Robinson C, Salama A, Levy JB. Neurological complications from brachial arteriovenous fistulae. Nephrol Dial Transplant 2004; 19:1923.
  19. Thermann F, Kornhuber M. Ischemic monomelic neuropathy: a rare but important complication after hemodialysis access placement--a review. J Vasc Access 2011; 12:113.
  20. Leon C, Asif A. Arteriovenous access and hand pain: the distal hypoperfusion ischemic syndrome. Clin J Am Soc Nephrol 2007; 2:175.
  21. Papasavas PK, Reifsnyder T, Birdas TJ, et al. Prediction of arteriovenous access steal syndrome utilizing digital pressure measurements. Vasc Endovascular Surg 2003; 37:179.
  22. Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 2004; 27:1.
  23. Lazarides MK, Staramos DN, Kopadis G, et al. Onset of arterial 'steal' following proximal angioaccess: immediate and delayed types. Nephrol Dial Transplant 2003; 18:2387.
  24. Crowley SD, Butterly DW, Peter RH, Schwab SJ. Coronary steal from a left internal mammary artery coronary bypass graft by a left upper extremity arteriovenous hemodialysis fistula. Am J Kidney Dis 2002; 40:852.
  25. Gaudino M, Serricchio M, Luciani N, et al. Risks of using internal thoracic artery grafts in patients in chronic hemodialysis via upper extremity arteriovenous fistula. Circulation 2003; 107:2653.
  26. Kato H, Ikawa S, Hayashi A, Yokoyama K. Internal mammary artery steal in a dialysis patient. Ann Thorac Surg 2003; 75:270.
  27. Asif A, Leon C, Merrill D, et al. Arterial steal syndrome: a modest proposal for an old paradigm. Am J Kidney Dis 2006; 48:88.
  28. Yilmaz C, Ozcan K, Erkan N. Dialysis access-associated steal syndrome presenting as bidirectional flow at duplex Doppler ultrasound. AJR Am J Roentgenol 2009; 193:W568.
  29. Moghazy KM. Value of color Doppler sonography in the assessment of hemodialysis access dysfunction. Saudi J Kidney Dis Transpl 2009; 20:35.
  30. Malik J, Slavikova M, Maskova J. Dialysis access-associated steal syndrome: the role of ultrasonography. J Nephrol 2003; 16:903.
  31. Tordoir JH, Van Der Sande FM, De Haan MW. Current topics on vascular access for hemodialysis. Minerva Urol Nefrol 2004; 56:223.
  32. Wixon CL, Hughes JD, Mills JL. Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access. J Am Coll Surg 2000; 191:301.
  33. Berman SS, Gentile AT, Glickman MH, et al. Distal revascularization-interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome. J Vasc Surg 1997; 26:393.
  34. Knox RC, Berman SS, Hughes JD, et al. Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access. J Vasc Surg 2002; 36:250.
  35. Diehl L, Johansen K, Watson J. Operative management of distal ischemia complicating upper extremity dialysis access. Am J Surg 2003; 186:17.
  36. Schanzer H, Eisenberg D. Management of steal syndrome resulting from dialysis access. Semin Vasc Surg 2004; 17:45.
  37. Goel N, Miller GA, Jotwani MC, et al. Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome. Kidney Int 2006; 70:765.
  38. Miller GA, Goel N, Friedman A, et al. The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome. Kidney Int 2010; 77:359.
  39. Centers for Disease Control and Prevention (CDC). Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005. MMWR Morb Mortal Wkly Rep 2007; 56:197.
  40. Fysaraki M, Samonis G, Valachis A, et al. Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis. Int J Med Sci 2013; 10:1632.
  41. Nguyen DB, Lessa FC, Belflower R, et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011. Clin Infect Dis 2013; 57:1393.
  42. D'Amato-Palumbo S, Kaplan AA, Feinn RS, Lalla RV. Retrospective study of microorganisms associated with vascular access infections in hemodialysis patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:56.
  43. Crowley L, Wilson J, Guy R, et al. Chapter 12 Epidemiology of Staphylococcus aureus bacteraemia amongst patients receiving dialysis for established renal failure in England in 2009 to 2011: a joint report from the Health Protection Agency and the UK Renal Registry. Nephron Clin Pract 2012; 120 Suppl 1:c233.
  44. Anderson JE, Chang AS, Anstadt MP. Polytetrafluoroethylene hemoaccess site infections. ASAIO J 2000; 46:S18.
  45. Laupland KB, Conly JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: an evidence-based review. Clin Infect Dis 2003; 37:933.
  46. Ayus JC, Sheikh-Hamad D. Silent infection in clotted hemodialysis access grafts. J Am Soc Nephrol 1998; 9:1314.
  47. Nassar GM, Ayus JC. Clotted arteriovenous grafts: a silent source of infection. Semin Dial 2000; 13:1.
  48. Nassar GM, Ayus JC. Infectious complications of old nonfunctioning arteriovenous grafts in renal transplant recipients: a case series. Am J Kidney Dis 2002; 40:832.
  49. Bosman PJ, Blankestijn PJ, van der Graaf Y, et al. A comparison between PTFE and denatured homologous vein grafts for haemodialysis access: a prospective randomised multicentre trial. The SMASH Study Group. Study of Graft Materials in Access for Haemodialysis. Eur J Vasc Endovasc Surg 1998; 16:126.
  50. McKenna PJ, Leadbetter MG. Salvage of chronically exposed Gore-Tex vascular access grafts in the hemodialysis patient. Plast Reconstr Surg 1988; 82:1046.
  51. Kovalik EC, Raymond JR, Albers FJ, et al. A clustering of epidural abscesses in chronic hemodialysis patients: risks of salvaging access catheters in cases of infection. J Am Soc Nephrol 1996; 7:2264.