UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

长期血液透析通路用动静脉瘘及人工血管内瘘

Author
Matthew J Oliver, MD, MHS
Section Editor
Steve J Schwab, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
倪冷, 主治医师

引言

长期血管通路的目的是建立可重复利用的并发症最小的循环通路。长期血液透析血管通路应尽可能使用动静脉通路，以避免中心静脉置管的风险。理想情况下，应使用患者自身血管创造一个动静脉瘘，但在没有适宜的自体血管可用时，也可以使用非自体材料。

动静脉瘘的类型、一般特点以及各种类型的比较将总结在此。紧急透析和长期血液透析情况下中心导管的使用以及血液透析血管通路的并发症将在别处讨论。 (参见“急性和慢性血液透析通路的中心静脉导管”和“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”和“长期血液透析动静脉血管通路的非血栓性并发症”和“血液透析中动静脉内瘘的再循环”和“Thrombosis associated with chronic hemodialysis vascular catheters”)

自体动静脉瘘

动静脉瘘通常是由一条动脉和静脉端侧吻合构建而成。最常使用的动静脉瘘是吻合桡动脉与头静脉所形成的瘘(桡-头瘘)或吻合肱动脉与头静脉所形成的瘘(肱-头瘘)或吻合肱动脉与贵要静脉所形成的瘘(肱-贵要瘘)。对于后者，贵要静脉可能被移动至通过皮下隧道转位到旁侧以便于穿刺(转位肱动脉-贵要静脉瘘)[1]。不常在肱动脉和前臂正中静脉间建立动静脉瘘[2]。也可以在下肢建立动静脉瘘，但很少需要采用这种方式[3]。

加拿大和美国指南均倾向于将桡动脉-头静脉自体血管瘘作为血管通路的首选[4,5]。肱动脉-头静脉瘘及肱动脉-贵要静脉瘘分别作为第二及第三选择[5]。

其他动静脉瘘 — 用其他生物材料建立的动静脉瘘，如隐静脉、脐静脉或动脉同种异体移植物，或牛动脉等异种移植物的性能并不优于聚四氟乙烯(polytetrafluoroethylene, PTFE)人工血管内瘘[6-8]。

                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-07-12.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Rodriguez JA, Armadans L, Ferrer E, et al. The function of permanent vascular access. Nephrol Dial Transplant 2000; 15:402.
  2. Chin AI, Chang W, Fitzgerald JT, et al. Intra-access blood flow in patients with newly created upper-arm arteriovenous native fistulae for hemodialysis access. Am J Kidney Dis 2004; 44:850.
  3. Gradman WS, Laub J, Cohen W. Femoral vein transposition for arteriovenous hemodialysis access: improved patient selection and intraoperative measures reduce postoperative ischemia. J Vasc Surg 2005; 41:279.
  4. 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.
  5. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48 Suppl 1:S2.
  6. Hurt AV, Batello-Cruz M, Skipper BJ, et al. Bovine carotid artery heterografts versus polytetrafluoroethylene grafts. A prospective, randomized study. Am J Surg 1983; 146:844.
  7. Liu Z, Zhu B, Wang X, et al. Clinical studies of hemodialysis access through formaldehyde-fixed arterial allografts. Kidney Int 2007; 72:1249.
  8. Canaud B. Formaldehyde-fixed arterial allograft as a novel vascular access alternative in end-stage renal disease patients. Kidney Int 2007; 72:1179.
  9. Hurlbert SN, Mattos MA, Henretta JP, et al. Long-term patency rates, complications and cost-effectiveness of polytetrafluoroethylene (PTFE) grafts for hemodialysis access: a prospective study that compares Impra versus Gore-tex grafts. Cardiovasc Surg 1998; 6:652.
  10. Lenz BJ, Veldenz HC, Dennis JW, et al. A three-year follow-up on standard versus thin wall ePTFE grafts for hemodialysis. J Vasc Surg 1998; 28:464.
  11. Schuman ES, Standage BA, Ragsdale JW, Gross GF. Reinforced versus nonreinforced polytetrafluoroethylene grafts for hemodialysis access. Am J Surg 1997; 173:407.
  12. Miller CD, Robbin ML, Barker J, Allon M. Comparison of arteriovenous grafts in the thigh and upper extremities in hemodialysis patients. J Am Soc Nephrol 2003; 14:2942.
  13. Ram SJ, Sachdeva BA, Caldito GC, et al. Thigh grafts contribute significantly to patients' time on dialysis. Clin J Am Soc Nephrol 2010; 5:1229.
  14. Al-Jaishi AA, Oliver MJ, Thomas SM, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis 2014; 63:464.
  15. Sands J, Miranda CL. Increasing numbers of AV fistulas for hemodialysis access. Clin Nephrol 1997; 48:114.
  16. Miller PE, Tolwani A, Luscy CP, et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999; 56:275.
  17. Lockhart ME, Robbin ML, McNamara MM, Allon M. Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients. Nephrol Dial Transplant 2004; 19:2564.
  18. Lok CE, Allon M, Moist L, et al. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 2006; 17:3204.
  19. Huijbregts HJ, Bots ML, Wittens CH, et al. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008; 3:714.
  20. Monroy-Cuadros M, Yilmaz S, Salazar-Bañuelos A, Doig C. Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol 2010; 5:1787.
  21. Silva MB Jr, Hobson RW 2nd, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27:302.
  22. Miller CD, Robbin ML, Allon M. Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int 2003; 63:346.
  23. Obialo CI, Tagoe AT, Martin PC, Asche-Crowe PE. Adequacy and survival of autogenous arteriovenous fistula in African American hemodialysis patients. ASAIO J 2003; 49:435.
  24. Segal JH, Kayler LK, Henke P, et al. Vascular access outcomes using the transposed basilic vein arteriovenous fistula. Am J Kidney Dis 2003; 42:151.
  25. Ravani P, Brunori G, Mandolfo S, et al. Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: a prospective multicenter study. J Am Soc Nephrol 2004; 15:204.
  26. van der Linden J, Lameris TW, van den Meiracker AH, et al. Forearm venous distensibility predicts successful arteriovenous fistula. Am J Kidney Dis 2006; 47:1013.
  27. Lee T, Barker J, Allon M. Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula. J Am Soc Nephrol 2007; 18:1936.
  28. Beathard GA, Settle SM, Shields MW. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis 1999; 33:910.
  29. Konner K, Hulbert-Shearon TE, Roys EC, Port FK. Tailoring the initial vascular access for dialysis patients. Kidney Int 2002; 62:329.
  30. Faiyaz R, Abreo K, Zaman F, et al. Salvage of poorly developed arteriovenous fistulae with percutaneous ligation of accessory veins. Am J Kidney Dis 2002; 39:824.
  31. Falk A, Teodorescu V, Lou WY, et al. Treatment of "swing point stenoses" in hemodialysis arteriovenous fistulae. Clin Nephrol 2003; 60:35.
  32. Beathard GA, Arnold P, Jackson J, et al. Aggressive treatment of early fistula failure. Kidney Int 2003; 64:1487.
  33. Nassar GM, Nguyen B, Rhee E, Achkar K. Endovascular treatment of the "failing to mature" arteriovenous fistula. Clin J Am Soc Nephrol 2006; 1:275.
  34. Dunlop MG, Mackinlay JY, Jenkins AM. Vascular access: experience with the brachiocephalic fistula. Ann R Coll Surg Engl 1986; 68:203.
  35. Sottiurai VS, Stephens A, Champagne L, et al. Comparative results of early and delayed cannulation of arteriovenous graft in haemodialysis. Eur J Vasc Endovasc Surg 1997; 13:139.
  36. Schild AF, Schuman ES, Noicely K, et al. Early cannulation prosthetic graft (Flixene™) for arteriovenous access. J Vasc Access 2011; 12:248.
  37. Rayner HC, Pisoni RL, Gillespie BW, et al. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003; 63:323.
  38. Brunori G, Ravani P, Mandolfo S, et al. Fistula maturation: doesn't time matter at all? Nephrol Dial Transplant 2005; 20:684.
  39. Saran R, Dykstra DM, Pisoni RL, et al. Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transplant 2004; 19:2334.
  40. Saran R, Pisoni RL, Young EW. Timing of first cannulation of arteriovenous fistula: are we waiting too long? Nephrol Dial Transplant 2005; 20:688.
  41. Bonalumi U, Civalleri D, Rovida S, et al. Nine years' experience with end-to-end arteriovenous fistula at the 'anatomical snuffbox' for maintenance haemodialysis. Br J Surg 1982; 69:486.
  42. Munda R, First MR, Alexander JW, et al. Polytetrafluoroethylene graft survival in hemodialysis. JAMA 1983; 249:219.
  43. Young EW, Dykstra DM, Goodkin DA, et al. Hemodialysis vascular access preferences and outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 2002; 61:2266.
  44. Polo JR, Tejedor A, Polo J, et al. Long-term follow-up of 6-8 mm brachioaxillary polytetrafluorethylene grafts for hemodialysis. Artif Organs 1995; 19:1181.
  45. Bender MH, Bruyninckx CM, Gerlag PG. The brachiocephalic elbow fistula: a useful alternative angioaccess for permanent hemodialysis. J Vasc Surg 1994; 20:808.
  46. Hodges TC, Fillinger MF, Zwolak RM, et al. Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg 1997; 26:1009.
  47. Coburn MC, Carney WI Jr. Comparison of basilic vein and polytetrafluoroethylene for brachial arteriovenous fistula. J Vasc Surg 1994; 20:896.
  48. Bay WH, Van Cleef S, Owens M. The hemodialysis access: preferences and concerns of patients, dialysis nurses and technicians, and physicians. Am J Nephrol 1998; 18:379.
  49. Oliver MJ, Rothwell DM, Fung K, et al. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol 2004; 15:1936.
  50. Dhingra RK, Young EW, Hulbert-Shearon TE, et al. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int 2001; 60:1443.
  51. Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among hemodialysis patients. Kidney Int 2002; 62:620.
  52. Xue JL, Dahl D, Ebben JP, Collins AJ. The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis 2003; 42:1013.
  53. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol 2004; 15:477.
  54. Thomson PC, Stirling CM, Geddes CC, et al. Vascular access in haemodialysis patients: a modifiable risk factor for bacteraemia and death. QJM 2007; 100:415.
  55. Pisoni RL, Arrington CJ, Albert JM, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009; 53:475.
  56. Astor BC, Eustace JA, Powe NR, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol 2005; 16:1449.
  57. Allon M, Daugirdas J, Depner TA, et al. Effect of change in vascular access on patient mortality in hemodialysis patients. Am J Kidney Dis 2006; 47:469.
  58. http://www.fistulafirst.org/LinkClick.aspx?fileticket=dtRHh5AoBiY%3D&tabid=86 (Accessed on October 02, 2013).
  59. Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int 2002; 62:1109.
  60. Lok CE, Oliver MJ. Overcoming barriers to arteriovenous fistula creation and use. Semin Dial 2003; 16:189.
  61. Asif A, Cherla G, Merrill D, et al. Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula. Kidney Int 2005; 67:2399.
  62. Malas MB, Canner JK, Hicks CW, et al. Trends in incident hemodialysis access and mortality. JAMA Surg 2015; 150:441.