肱动脉-头臂静脉内瘘——慢性肾功能衰竭成功的次选血管通路

Brachio-cephalic arteriovenous fistula: a successful alternative vascular access in chronic hemodialysis patients

目的 对肱动脉 头臂静脉内瘘及前臂袢型PTFE人造血管的生存率及并发症进行分析比较。方法 对 1997年 10月～ 2 0 0 0年 10月间 34例共 35次肱动脉 头臂静脉内瘘手术及 2 9例共 36次PTFE人造血管术进行回顾性分析。所有患者均为以前桡动脉 头臂静脉内瘘失败或丧失功能者。结果 肱动脉 头臂静脉内瘘及PTFE人造血管 1年、2年、3年的生存率分别为 96 .43%和 5 4.2 3%、96 .43%和 48.2 2 %、48.2 2 %和 39.19%(P <0 .0 1)。PTFE人造血管术后并发症次数及最终血管通路丧失功能的数目均明显多于肱动脉 头臂静脉内瘘术 (P <0 .0 1)。PTFE术后并发症以血栓形成最常见 ,其他并发症包括感染、假性动脉瘤、人造血管外露和血清瘤等 ,均需外科手术干预。结论 上臂肱动脉 头臂静脉使用寿命长 ,并发症少 ,作为桡动脉

Objective To compare the patency and complications between branchio cephalic(B C) arteriovenous fistulas and forearm loops Polytetrafluorothylene(PTFE) grafts. Methods In the period between Oct 1997 to Oct 2000, 35 B C fistulas and 36 PTFE grafts were constructed in 34 and 29 patients respectively after failure of primary radial cephalic fistulas. Kaplan meier survival curves were calculated to determine the cumulative patency. Results The 1, 2, 3 years cumulative patency rates of B C fistulas and PTFE grafts were 96.43% vs 54.23%, 96.43% vs 39.19%, 48.22% vs 39.19% respectively, which were much higher in the former group( P <0.01), while the total number of complications and the number of loss of function were much higher in the latter group( P <0.01). Those complications occurred in PTFE graft group included thrombosis, infection, graft exposure, pseudoaneurysm formation and seroma, among which thrombosis was most common. Surgical interventions were indispensable for all these complications. Conclusion In case primary radial cephalic fistula fails, the end to side B C fistula is a cost effective second choice of vascular access procedure and which is more preferable compared with forearm loops PTFE graft.