中国修复重建外科杂志

中国修复重建外科杂志

胸壁人工血管透析通路的远期疗效报道

查看全文

目的 探讨胸壁人工血管透析通路(chest wall arteriovenous graft,CWAVG)作为终末期肾病血液透析通路的远期疗效。 方法 回顾分析 2014 年 1 月—2015 年 6 月,因上肢血管通路耗竭而建立 CWAVG 的 12 例终末期肾病患者临床资料。其中男 3 例,女 9 例;年龄 54~82 岁,平均 63.6 岁。慢性肾病病因:慢性肾小球肾炎 2 例,高血压肾损害 4 例,糖尿病肾病 1 例,泌尿系肿瘤、双肾切除术后 3 例,不详 2 例。血液透析时间 1~144 个月,平均 38.4 个月。行 CWAVG 前通路失功次数 1~14 次,平均 4.2 次,均因透析通路反复闭塞或上肢血管条件极差造成上肢血管通路耗竭。 结果 12 例患者均获随访,随访时间 30~48 个月,平均 35.4 个月。2 例患者死亡,其中 1 例消化道大出血,1 例心力衰竭。余 10 例于术后 6 周左右开始应用 CWAVG 进行透析,术后 6、12、18、24、30 个月的初级通畅率分别为 83.3%、75.0%、33.3%、33.3%、16.7%,累计通畅率分别为 83.3%、75.0%、50.0%、33.3%、16.7%。8 例 CWAVG 失功患者中,6 例血栓形成,1 例血清肿,1 例椎动脉窃血;其中 4 例改行长期透析管透析,3 例改行其他肢体内瘘,1 例未予以血液透析治疗。 结论 在上肢自体血管资源耗竭的情况下,CWAVG 是上肢血液透析通路的重要手术备选方案之一;但其远期通畅率尚待进一步提高。

Objective To explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease. Methods A retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity. Results All patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis. Conclusion Although the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.

关键词: 人工血管动静脉内瘘; 胸壁人工血管透析通路; 远期通畅率; 血液透析

Key words: Arteriovenous graft; chest wall arteriovenous graft; long-term patency rate; hemodialysis

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Sidawy AN, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg, 2008, 48(5 Suppl): 2S-25S.
2. Gale-Grant O, Chemla ES. Single-center results of a series of prosthetic axillary-axillary arteriovenous access grafts for hemodialysis. J Vasc Surg, 2016, 64(6): 1741-1746.
3. Dracon M, Watine O, Pruvot F, et al. Axillo-axillary access in hemodialysis. Nephrologie, 1994, 15(2): 175-176.
4. Morsy MA, Khan A, Chemla ES. Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: a prospective single-center experience. J Vasc Surg, 2008, 48(5): 1251-1254.
5. 成功, 张宪生, 尹杰, 等. 胸壁与上肢人工血管透析通路的通畅率及影响因素比较. 中国微创外科杂志, 2016, 16(4): 289-293.
6. 尹杰, 佘康, 张宪生, 等. 胸壁人工血管透析通路的中期疗效报道. 中国修复重建外科杂志, 2015, 29(9): 1129-1132.
7. Price AJ, Fidelman N, Wilson MW, et al. Percutaneous interventions in failing " necklace” hemodialysis grafts: long-term outcomes. J Vasc Interv Radiol, 2014, 25(2): 199-205.
8. Hunter JP, Nicholson ML. Midterm experience of ipsilateral axillary-axillary arteriovenous loop graft as tertiary access for haemodialysis. J Transplant, 2014, 2014: 908738.
9. Mohamed IH, Bagul A, Doughman T, et al. Axillary-axillary loop graft for hemodialysis access. J Vasc Access, 2011, 12(3): 262-263.
10. Antoniou GA, Lazarides MK, Georgiadis GS, et al. Lower-extremity arteriovenous access for haemodialysis: a systematic review. Eur J Vasc Endovasc Surg, 2009, 38(3): 365-372.
11. McCann RL. Axillary grafts for difficult hemodialysis access. J Vasc Surg, 1996, 24(3): 457-461.
12. Otani M, Takeo M, Nakajima Y. Anterior chest wall arteriovenous graft for dialysis. J Vasc Access, 2013, 14(2): 207.
13. Jean-Baptiste E, Hassen-Khodja R, Haudebourg P, et al. Axillary loop grafts for hemodialysis access: midterm results from a single-center study. J Vasc Surg, 2008, 47(1): 138-143.
14. Frampton AE, Hossain M, Hamidian Jahromi A, et al. Rescue of an axillary-axillary arteriovenous graft not amenable to endovascular intervention by formation of an axillary loop: a case report. J Vasc Access, 2009, 10(1): 55-58.
15. Bachleda P, Utikal P, Kocher M, et al. Arteriovenous graft for hemodialysis, graft venous anastomosis closure - current state of knowledge. Minireview. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(1): 27-30.
16. Park BJ, Kim HR, Chung HH, et al. Percutaneous intervention in axillary loop-configured arteriovenous grafts for chronic hemodialysis patients. Korean J Radiol, 2010, 11(2): 195-202.
17. Haskal ZJ, Trerotola S, Dolmatch B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med, 2010, 362(6): 494-503.
18. Shenoy S, Miller A, Petersen F, et al. A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique. J Vasc Surg, 2003, 38(2): 229-235.
19. Dixon BS, Beck GJ, Vazquez MA, et al. Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med, 2009, 360(21): 2191-2201.