老年肾衰患者建立前臂近端自体动静脉内瘘临床效果的研究进展

老年患者为终末期肾病(ESRD)的主要群体,且多数同时患有糖尿病及高血压等合并症。ESRD的主要治疗手段为肾移植和血液透析,由于肾源匮乏,现阶段仍依赖血液透析。血管通路的建立是维持血液透析治疗的首要条件,国内外的血管通路指南都将自体动静脉内瘘(AVF)作为维持性血液透析患者的首选血管通路。AVF具有使用周期久、并发症少的优点。而老年患者由于血管钙化、内膜增生和外周血管疾病,建立AVF困难,后续AVF也常存在失功状况,需进行干预补救。由于前臂血管资源宝贵,大多数专家认为AVF的建立原则为先前臂远心端血管,后近心端血管。本文认为对于血管条件不佳的老年患者可优先建立前臂近心端血管通路,具有较前臂远心端内瘘成熟期提前、首次穿刺成功率高及2年的内瘘通畅率高的优势,为血管外科医师在老年ESRD患者建立血管通路方面提供新的思路。

Research progress in effect of an autologous arteriovenous fistula at proximal forearm in elderly patients

The elderly constitute the main patient population of end stage renal disease (ESRD), and most of them had diabetes, hypertension and other complications. The main treatment for ESRD has been renal transplantation and hemodialysis. Because of scare kidney source, hemodialysis dominates the treatment at present. The guidelines for vascular pathways both at home and abroad set arteriovenous fistula (AVF) as the primary choice for patients undergoing maintenance hemodialysis. AVF enjoys advantages of long service life and fewer complications, but its establishment is difficult in the elderly patients due to vascular calcification, intimal hyperplasia and peripheral vascular diseases. The established AVF often has dysfunction, which requires intervention and remedy. Because the blood supply system in the forearm is valuable, most experts recommend that the principle of establishing AVF be in the sequence of the distal end of the arm and the posterior proximal end to the heart. This paper proposes that the establishing vascular pathway in the proximal forearm should be prioritized in the elderly patients with poor quality of blood vessels with advantages over the AVF at the distal end to the heart in terms of earlier maturation, higher success rate of first puncture and higher 2-year potency rate of of internal fistula. This provides a new idea for vascular surgeons to establish vascular pathway in the elderly patients with end-stage nephropathy.