血透用动静脉内瘘121例翻修体会

Experience of 121 cases of revision of arteriovenous fistula

目的总结血透用动静脉内瘘(arteriovenous fistula,AVF)翻修的原因及方法。方法回顾性分析121例AVF翻修的临床资料。结果本组病例中血栓形成108例,狭窄8例,动脉瘤4例,渗血1例。前臂端端吻合桡动脉与头静脉、贵要静脉和前臂正中静脉分别为79例、6例和1例,肘部端端吻合桡动脉与头静脉、肘正中静脉和贵要静脉分别为5例、6例和1例,上臂端侧吻合肱动脉与头静脉、肘正中静脉和贵要静脉分别为2例、1例和1例,19例行对侧造瘘。120例(占99.2%)1次手术再通。102例(占84.3%)翻修再造内瘘,其中86例(占84.3%)续用原AVF的静脉,术后24~48 h内即可使用AVF。结论 AVF翻修是紧急重建内瘘的良好方法 。

Objective To summarize the causes and approaches of revision of arteriovenous fistula(AVF) in patients undergoing maintenance hemodialysis.Methods The clinical data of 121 cases of revision of AVF were retrospectively analyzed.Results Thrombosis occurred in 108 cases,vascular stenosis in 8 cases,aneurysm in 4 cases,and fistula bleeding in 1 case.End to end anastomosis of the radial artery-cephalic vein,radial artery-basilic vein and radial artery-median vein in the forearm was carried out in 79 cases,6 cases and 1 case respectively.End to end anastomosis of the radial artery-cephalic vein,radial artery-median cubital vein and radial artery-basilic vein in the elbow was performed in 5 cases,6 cases and 1 case respectively.End to side anastomosis of the brachial artery-cephalic vein,brachial arterymedian cubital vein and brachial artery-basilic vein in the upper arm was made in 2 cases,1 case and 1 case respectively.Besides,operations were conducted in the forearm of the opposite side in 19 cases.A total of 120 cases successed to reconstruct fistula,with the success rate of 99.2%.102 cases(84.3%) successed to overhaul the AVF.86 cases(84.3%) continued to use the original vein,who could use the AVF in 24-48 hours after surgery.Conclusions Revision of AVF is a favorable emergency way to reconstruct fistula in patients undergoing maintenance hemodialysis.