Fogarty导管在老年内瘘血管栓塞中的应用

进行血液透析治疗的终末期肾衰竭患者首先要解决的问题是血管通路的建立，一条好的血管通路，能够延长患者的生命，减轻患者的痛苦，并能够提高患者的生活质量。老年患者建立自体内瘘的困难较多，而由于患者自身血管条件、血管内膜增生、反复穿刺、吻合口狭窄、低血压等原因造成瘘管流量不足，导致血栓形成是动静脉内瘘（AVF）失效的最主要原因。     

CT血管成像在维持性血液透析患者自体动静脉内瘘功能不良诊断中的应用

目的 探讨CT血管成像（CTA）对维持性血液透析（MHD）患者自体动静脉内瘘（AVF）功能不良的影像学诊断价值.方法 回顾性分析自体AVF功能不良MHD患者的临床资料,应用CTA明确内瘘狭窄的部位、数目、程度等.结果 48例次临床诊断自体AVF功能不良的MHD患者,经CTA显示内瘘狭窄病变共86处,其中局限性狭窄51处（59.3％）,节段性狭窄35处（40.7％）.自体AVF位于前臂患者41例次狭窄共77处,近吻合口动脉狭窄9处（11.7％）,吻合口狭窄12处（15.6％）,近吻合口狭窄37处（48.0％）,流出道狭窄共19处（24.7％）,其中远心端距吻合口3～5 cm 14处（18.2％）;5～10 cm 4处（5.2％）;＞10cm 1处（1.3％）;自体AVF位于上臂患者7例次狭窄共9处,近吻合口狭窄6处（66.7％）,流出道狭窄3处（33.3％）,其中远心端距吻合口3～5cm 1处（11.1％）;5 ～10 cm 2处（22.2％）.血管狭窄程度25％ ～ 49％ 10例次（20.8％）,50％ ～74％ 25例次（52.1％）,75％ ～99％ 13例次（27.1％）.结论 CTA可准确评估MHD患者自体AVF功能不良的内瘘血管狭窄部位、数量及程度,为进一步手术干预提供参考价值.     

动静脉内瘘血管内膜增生的细胞和分子病理机制

动静脉内瘘(AVF)是绝大多数维持性血液透析患者首选的血管通路,AVF失功是维持性血液透析患者住院的重要原因。本文就AVF失功的主要病理基础——血管内膜增生的细胞和分子病理机制研究进展做一综述。     

上肢高位动静脉内瘘建立在老年血液透析患者的应用

目的 评价各种上肢动静脉内瘘在老年血液透析患者中的应用效果和主要并发症.方法 对46例尿毒症血液透析患者行直接动静脉内瘘,分高位组(前臂上端及肘窝处)26例,腕部标准组20例,比较两组内瘘的血流量、成熟时间、开始应用时间、通畅率及并发症.结果 两组在成熟时间、开始应用时间无显著差异,但内瘘血流量差异显著(P＜0.05).高位组内瘘闭塞2例,标准组内瘘闭塞2例.血栓形成发生率分别为7.69%和6.67%(P＞0.05).结论 高位动静脉内瘘血流量好、通畅率高,为血管条件差的老年患者建立血液透析血管通路的最佳选择.     

老年血液透析患者动静脉内瘘78例临床分析

血液透析是目前终末期尿毒症的主要治疗手段。用于血液透析的永久性血管通路最常用的方法为自身动静脉内瘘的建立 ,而老年患者由于心血管病变因素的影响 ,动静脉内瘘的建立较非老年组有所差异 ,现就本院 78例老年血液透析患者动静脉内瘘的建立作临床分析。临床资料 :本组 78例均为各种原因所致的终末期尿毒症患者。男 43例 ,女 35例 ;年龄 60～ 81岁 ,平均 70 .5岁。尿毒症症状严重者 ,术前在颈内静脉插管行血液透析 ,其症状缓解后行动静脉内瘘手术。方法 :选用手腕部头静脉—桡动脉端端吻合或端侧吻合术。其中端端吻合者 31例 ,端侧吻合者 …     

血液透析患者动静脉内瘘与心血管系统并发症

血管通路的选择对血液透析治疗至关重要,自体动静脉内瘘(AVF)可明显改善血液透析患者的生活质量。然而,由于终末期肾病患者心血管事件发生率高,包括左室肥大、容量负荷和内皮细胞功能紊乱等,在AVF建立后,使已经较为复杂的病理生理学变得更为复杂。AVF可引起心血管血流动力学包括体循环和肺循环的改变,导致了心脏结构、功能和肺循环的适应失调等,进而影响血液透析患者的心肺功能、生活质量和生存率。全面了解AVF对心血管系统的影响,可为AVF相关的心血管并发症的预防和治疗提供理论依据。     

血管通路类型对新血液透析患者炎症的影响

目的研究不同的血管通路类型对新血液透析(HD)患者炎症状态的影响,为HD患者选择最优血管通路。方法对150例新HD患者进行前瞻性观察研究。按血管通路类型分为4组,半永久性置管(TC)组40例,自体动静脉内瘘(AVF)组50例,临时置管+自体动静脉内瘘(C+AVF)组50例,动静脉移植血管(AVG)组10例。分别在建立血管通路前及建立血管通路1年内测定血清C反应蛋白(CRP)水平共7次。以CRP为因变量,校正年龄、性别、冠脉疾病、糖尿病、感染、通路血栓、HD和手术后天数,进行混合效果模式分析。并记录各组3月内死亡率。结果与AVF相比,采用TC和AVG者血清CRP水平明显升高,而C+AVF者无显著变化。混合效果模式分析标明血管通路类型(TC、AVG)是重要的预测因素。结论患者开始HD应用TC或AVG体内炎症状态增高,可能促进HD开始后90 d死亡率升高。HD患者选用AVF或C+AVF血管通路可减少体内炎症发生。     

动静脉内瘘在老年透析患者中的应用

<正>透析患者人群逐步进入老龄化~([1]),据报道,美国>75岁的老年终末期肾脏病患者2000~2013年增长了44%,远远大于20~44岁(增长率为14%)和45~64岁(增长率为19%)~([2])。我国近10年内的血液透析患者血管通路仍主要以动静脉内瘘(AVF)为主,同时长期性中心静脉导管(CVC)也得到了广泛应用,透析用血管通路出现多元化趋势,在这种背景之下,老年患     

不同类型血管通路的老年长期血液透析患者并发症比较

目前临床上肾衰竭的治疗主要依赖于血液透析.建立可靠的血管通路是维持血液透析治疗效果的关键环节之一.本研究旨在比较不同手术方式建立血管通路的临床效果与并发症的差异. 1资料与方法 1.1临床资料回顾性分析2010年1月至2011年12月我院进行长期血液透析的253例患者建立长期动静脉内瘘(AVF)的临床资料.均为各种肾脏疾病导致的终末期慢性肾衰竭,其中男136例,女117例,年龄60～78岁,平均(66.4±22.8)岁.     

维持性血液透析血管通路抗凝治疗多中心流行病学研究

目的 了解血液透析患者血管通路的使用和维护情况,并评估患者的抗凝治疗以及出血、血栓并发症的情况。方法 对中国北方城市7个血液净化中心的1175例患者进行血液透析血管通路选择及抗凝治疗的流行病学调查。依据血管通路不同,分为自体动静脉内瘘组(AVF)及长期留置中心静脉导管组(CVC),比较两组患者抗凝治疗及出血、血栓并发症的异同。结果 中国北方城市血液透析患者最常使用的血管通路为自体动静脉内瘘,最常用的抗凝剂是普通肝素。CVC组患者更多选择低分子肝素(LMWH)做为抗凝剂,其血栓并发症的发生率高于AVF组;并发血栓的患者没有增加LMWH的使用剂量,也没有增加口服抗血小板药物的使用率;中心静脉导管的肝素封管浓度明显过高,可能给患者带来出血风险。结论 中国血液透析的抗凝治疗尚需改进,尤其是对于使用CVC的患者。有必要开展临床评价研究,建立适宜的抗凝方案,推进血液透析患者抗凝治疗的规范化和标准化。     

前臂近端自体动静脉内瘘在老年血液透析病人中的应用

目的探讨老年血液透析病人在前臂近端建立自体动静脉内瘘的优劣性及临床转归。方法选取在我院进行首次自体动静脉内瘘建立的老年病人,分为近端组(桡动脉起始段与正中静脉或头静脉吻合)和远端组(桡动脉与头静脉吻合),观察2组病人内瘘术后的手术并发症以及内瘘血流量、成熟情况及预后等。结果所有内瘘手术术后即刻成功率为100%。术后6~8周进行内瘘超声评估,近端组和远端组的血流量分别为(1328.5±234.4)mL/min和(1125.6±198.1)mL/min(P<0.05),首次穿刺时间分别为(56±15)d和(62±13)d(P=0.03),首次穿刺成功率分别为87.8%和78.9%(P<0.05)。2组术后总体并发症发生率差异无统计学意义(P>0.05);所有手术6个月的总体通畅率为92.41%,1年的总体通畅率为81.01%。2组病人1年的内瘘存活率差异无统计学意义(85.2%比74.1%,P=0.32),但在第2年时,近端组的存活率为74.3%,明显高于远端组的48.3%(P<0.05);同时近端组由于血栓形成而导致的内瘘闭塞率及再次手术干预次数也低于远端组(P<0.05)。结论前臂近端自体动静脉内瘘具有成熟快、流量充足、通畅率高等优点,对于前臂远端血管条件不佳、需建立内瘘的老年人,尤其是高龄病人可以优先考虑。     

彩色多普勒超声对长期血液透析老年患者动静脉内瘘并发症的监测作用

目的 探讨彩色多普勒超声检测老年人长期血液透析动静脉内瘘并发症的临床应用价值.方法 36例血液透析老年患者,其中27例采用自体动静脉瘘,9例因自身血管条件限制,不能建立理想的血管通路,采用人工血管移植建立动静脉瘘,应用彩色多普勒超声检测动静脉内瘘的功能及其并发症的发生情况.结果 36例老年血液透析患者中,26例(72....     

Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases

Microsurgery for angioaccess in children includes the use of a surgical microscope, microsurgical instruments, prophylactic tourniquet-induced hemostasis and no-touch surgery. In the recent publications concerning angioaccess in children, the percentages of grafts versus arteriovenous fistulas (AVF) varied from 54 to 76% without microsurgery, and from 0 to 14% with microsurgery. Similarly, the percentages of AVF which failed to mature varied from 30 to 33% without microsurgery, and from 5 to 10% with microsurgery. In a personal series of 380 children receiving hemodialysis, 434 microsurgical angioaccesses were created, 78% being distal autologous AVF. Eighty-five percent of the distal radial-cephalic AVF were patent after 2 years and 60% after 4 years. These results of microsurgically created AVF are probably responsible, at least in part, for the high percentage of end-stage renal disease (ESRD) children treated by hemodialysis on 1 February 2003 in Paris using an autologous fistula (70% of 33 children), while only 24% were hemodialyzed via a central venous catheter and 6% were on peritoneal dialysis. This compares favorably with the annual publication of the North American Pediatric Renal Transplant Cooperative Study in 1996 reporting that two-thirds of the dialysis population were maintained on peritoneal dialysis and that the majority of hemodialysis accesses were external percutaneous catheters. Microsurgical AVF are also created successfully in non-ESRD children requiring frequent blood access for various chronic diseases. It has been possible to create a distal AVF in 68% of cases and the long-term patency rate was just below 60% after 10 years. Microsurgery is mandatory for creation of arteriovenous fistulas, the best form of angioaccess for children treated by hemodialysis or requiring repeated access to blood in various non-renal diseases.     

A new arteriovenous fistula model to study the development of neointimal hyperplasia

This study describes an alternative arteriovenous fistula (AVF) model in the rat in which the animals develop significant neointimal hyperplasia (NIH) not only at the distal anastomotic site, but also throughout the fistula body. This aortocaval fistula was established by anastomosing the distal end of the renal vein to the abdominal aorta after unilateral nephrectomy. The increased hemodynamic stress resulting from exposing the renal vein to the arterial circulation induced venous NIH as early as 7 days after surgery. This experimental AVF was characterized by the early lack of endothelium, the accumulation of proliferating vascular smooth muscle cells and the neovascularization of the fistula adventitia. In summary, we have described an informative animal model to study the pathobiology of NIH in native AVF.     

老年血透患者动静脉内瘘并发症监测及其影响因素分析

目的检测老年血透患者动静脉内瘘（AVF）并发症发生率并分析其血流动力学参数与影响因素。方法采用高频B超检测41例老年血透患者临床功能正常的AVF并发症情况及血流动力学参数,并记录临床及生化数据,按狭窄和血栓有无分为阳性组和阴性组。对两组各数据进行比较,并对并发症产生的各危险因素进行Logistic回归分析。结果AVF临床功能正常的老年血透患者隐匿性并发症发生率为39．02％。并发症阳性组患者与阴性组患者供血桡动脉内径（P=0．015）、血流量（P=0．015）、桡动脉舒张末期血流速度（P=0．038）间差别有统计学意义。而阻力指数（P=0．009）间差异有高度统计学意义。阳性组患者与阴性组患者收缩压差异有统计学意义（P=0．042）,血浆前白蛋白、高密度脂蛋白和血磷水平差异均有高度统计学意义（P值均〈0．001）。Logistic多元回归分析结果提示高血磷水平（P=0．017）是AVF并发症发生的主要危险因素,而低前白蛋白（P=0．020）和低高密度脂蛋白水平（P=0．024）是保护因素。结论老年血透患者临床功能正常的AVF中存在较高比例的隐匿性并发症,供血桡动脉的血管病变是AVF并发症发生及通路失功的重要影响因素。高磷血症的纠正、营养不良和脂质紊乱的改善、良好的血压控制,对降低AVF并发症发生、延长通路存活期具有重要意义。     

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??Objective To increase the understanding of vascular access in hemodialysis and to evaluate hemodialysis-related anticoagulation treatments and the associated hemorrhagic or thrombotic complications.Methods In this study??an epidemiological investigation was conducted in 1175 patients who underwent hemodialysis in seven blood purification centers in northern Chinese.The patients were divided into two groups based on the vascular access they used??arteriovenous fistula (AVF) group and central venous catheter (CVC) group.Results AVF was the most frequently used vascular access??and heparin was the most commonly used anticoagulant.Patients in CVC group experienced significantly greater rates of low molecular weight heparin (LMWH) administration??and had a higher rate in achieving thrombotic complications than those in AVF group.There were no significant differences in LMWH dosages in patients with thrombotic complications??as well as the proportion of patients who received antiplatelet drugs.Heparinized catheter lock solutions were excessively high in this study??which may lead to a risk of hemorrhage.Conclusion Hemodialysis-related anticoagulation treatments in China require additional improvements??especially for the patients using CVC as vascular access.There is an urgent need to develop clinical evaluation studies of anticoagulation treatments for achieving more standardized and targeted treatments.     

Risk Factors for Early Failure of Arteriovenous Vascular Access Among Patients With Type 2 Diabetes Mellitus

The aim of the study was to identify the potential risk factors for early arteriovenous access failure in a diabetic population. The data of 223 end‐stage renal disease (ESRD) patients with type 2 diabetes who had an arteriovenous fistula (AVF) or arteriovenous graft (AVG) placed as their initial vascular accesses were retrospectively reviewed. The association between clinical factors and risk for early failure was then analyzed. In multivariate analysis, the predictors associated with early failure were female gender (odds ratio (95% confidence interval): 2.52 (1.32–4.81); P = 0.005), AVF with prior peritoneal dialysis (3.26 (1.05‐10.11); P = 0.039), and lower hemoglobin level (P = 0.015). The results of significant predictors in the AVF group remained similar to the entire study population. In conclusion, there was an association of female gender, AVF with prior peritoneal dialysis and lower hemoglobin level with early arteriovenous access failure in a diabetic ESRD population.     

Self‐Care on Hemodialysis: Behaviors With the Arteriovenous Fistula

End stage renal disease (ESRD) patients should be educated to maintain and preserve the arteriovenous fistula (AVF) in the best condition. The purpose of this work was to evaluate self‐care frequency and factors that influenced such frequency. A prospective study was performed in 101 hemodialysis patients. Self‐care behaviors were measured with the Scale of Assessment of Self‐Care Behaviours with Arteriovenous Fistula in Hemodialysis. A regression model was used to determine the relevant predictors of self‐care frequency and their influence. The incidence of self‐care behaviors was 71.0%. The regression model showed that self‐care behaviors were positively influenced by gender (female), ESRD etiology (hypertension, polycystic kidneys and other kidney diseases), duration of AVF and negatively by the existence of previous AVF and health professional (doctor). The frequency of self‐care behaviors was lower than expected and below an appropriate standard. Education programs designed to improve self‐care behaviors with AVF should be further explored in a prospective randomized trial.     

Preoperative and Intraoperative Factors for Early Failure of Native Arteriovenous Fistulas

The aim of the study was to assess the potential predictive factors for early arteriovenous fistula (AVF) failure following the fistula first initiative. We retrospectively reviewed the data of 159 end‐stage renal disease (ESRD) patients who underwent AVF creation. The preoperative factors such as demographic, comorbidity condition, laboratory parameters and medication, and intraoperative or surgical‐related factors were assessed. In multivariate logistic regression analysis, significant predictive factors of early AVF failure were female gender (odds ratio (95% confidence interval): 2.63 (1.19–5.81); P = 0.017), higher body mass index (P = 0.038), and lower hemoglobin level (P = 0.048), while adjusting for preoperative factors or all factors. For adjusting of intraoperative factors, reduced venous diameter (P = 0.056) tended to be associated with early AVF failure. In conclusion, female gender, higher body mass index and lower hemoglobin level predicted the occurrence of early AVF failure in ESRD patients.