桡动脉-头静脉瘘成熟障碍原因分析及治疗的研究进展

Analysis of the Causes and Progress in the Treatment of Impaired Maturation of Radio-cephalic Fistula for Haemodialysis

桡动脉-头静脉瘘因其通畅率高、并发症少而被认为是血液透析血管通路的第一选择,但高达50%的内瘘因各种原因不能成熟,这主要是由于持续性地低血流量或穿刺困难导致无法进行充分的血液透析。常见的原因有流入道或流出道狭窄、吻合口狭窄、静脉位置过深及分支静脉的分流。此外,血栓形成是造成狭窄的一个常见原因。术前通过体格检查和超声检查评估血管条件选择合适的血管对于内瘘的成熟有着重要的意义。应针对引起成熟障碍的病因选择合适的治疗方法:术后普遍应用阿司匹林预防血栓形成进而减少狭窄的发生;外科手术有绕过损伤区域的优点但却创造一个新的吻合;近年来血管腔内技术因其微创的特点在大多数时候是第一选择。本文将对内瘘成熟障碍的定义、病因、诊断及治疗进行综述。

Radial-cephalic arteriovenous fistula （RCAVF） is considered the first choice for hemodialysis vascular access because of its high patency rate and less complications. But up to 50% of the fistula can not mature. This is mainly due to persistent low blood flow or difficulty in cannulation can not lead to adequate hemodialysis. Inflow or outflow stenosis, anastomotic stenosis, exceedingly deep location of the vein, flow diversion into accessory veins are the common causes of impaired maturation. In addition, thrombosis is a common of stenosis. Preoperative assessment by physical examination and ultrasound examination of blood vessels, select the appropri- ate blood vessels for the fistula is of great significance. Choose the appropriate treatment for the cause of maturation disorders. Postopera- tive aspirin is widely used to prevent thrombosis and reduce the occurrence of stenosis; Surgery has the advantage of bypassing the damaged area but creating a new stoma; in recent years, endovascular technique because of its characteristics of minimally invasive in most of the time is the first choice. In this paper, the definition, etiology, diagnosis and treatment of fistula maturation disorder are reviewed.