自体动静脉内瘘失功后的血管通路选择

Selection of vascular access after autologous arteriovenous fistula failure

动静脉内瘘失功是血液透析患者血管通路常见的并发症。一旦动静脉内瘘失功,将面临进一步的血管通路选择问题。目前有8种技术可以解决自体动静脉内瘘失功后的血管通路问题,即经皮腔内血管成形术、静脉内膜增生物剥离/内瘘重建、远离狭窄部位的内瘘重建、重新建立自体内瘘(导管过渡)、移植物内瘘、中心静脉导管、手术切开取栓和内瘘血管搭桥。原则上能修复的内瘘尽最大可能修复,以保护血管资源,提高自体动静脉内瘘使用率。综合考虑,应优先选择手术修复,其次是经皮腔内血管成形术。其他的选择应根据患者的具体情况而定。

Arteriovenous fistula failure （AVF） is a common complication of vascular access in patients on hemodialysis. Once AVF fails, we face a further selection of vascular access. Currently there are 8 techniques to resolve this problem, such as percutaneous transluminal angioplasty, venous neointimal hyperplasia （VNH） stripping/AVF reconstruction, AVF reconstruction proximal to the original fistula, creation of a new AVF, arteriovenous graft, central vein catheter, surgical thrombectomy, and vascular bypass operation using venous fistula. Principally, in order to protect the resources of blood vessels and increase the proportion of AVF use, we must do our best to repair AVF if possible. Taking into comprehensive consideration, we should give exclusive priority to repair surgically, followed by the percutaneous transluminal angiography （PTA）. Other choices should be based on the patient＆#39;s specific situation.