Vascular Access Grafts for Chemotherapy Use in Forty Patients at M. D. Anderson Hospital
Vascular Access Grafts for Chemotherapy Use in Forty Patients at M. D. Anderson Hospital
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M.D. Anderson 医院的 40 名患者接受血管通路移植用于化疗
作者：
J. Raaf;D. Phil.
对40例浅静脉狭窄或硬化的患者放置了42根动静脉桥，为其提供血管通路。39名患者患有恶性疾病，需要化疗，而1名再生障碍性贫血患者需要频繁输血。32个移植物放置在手臂(27直，5个环状)，10个放置在小腿(股-股环状)。37个分流管由6 mm聚四氟乙烯(PTFE)组成，5个分流管为6 mm涤纶。采用直臂动脉-腋静脉PTFE移植物为首选，PTFE股静脉环移植物为理想的移植物。带环臂移植物并发症发生率高，不再使用。除一名3岁儿童外，所有病例均采用了局部麻醉。没有手术死亡率和严重的并发症，尽管随后通过这些移植物注射的化疗药物抑制了骨髓。30名患者还活着，10名患者死于恶性肿瘤。26枚移植物功能良好，平均植入时间4.4个月(范围1~14个月)。患者，特别是门诊化疗单位的工作人员对该方案的接受度很高。血管通路移植物可以安全地插入，并为抽取血液样本、对选定的肿瘤患者进行化疗和间歇静脉治疗提供了一种方便的途径。
Forty-two arteriovenous grafts were placed to provide vascular access in 40 patients with poor or sclerosed superficial veins. Thirty-nine patients had malignant disease and required chemotherapy, while one patient with aplastic anemia needed frequent transfusions. Thirty-two grafts were placed in the arm (27 straight and 5 loop), and ten in the leg (femoral-femoral loop). Thirty-seven shunts consisted of 6 mm polytetrafluoroethylene (PTFE), and five were 6 mm Dacron®. The straight brachial artery to axillary vein PTFE graft was preferred, while the PTFE femoral loop graft was a satisfactory alternative. The loop arm graft was associated with a high complication rate and is no longer used. Local anesthesia was employed in all cases except for a 3-year-old child. There was no operative mortality and no severe morbidity, despite subsequent myelosuppression by chemotherapeutic agents injected via these grafts. Thirty patients arc alive, while ten died of their malignancy. Twenty-six grafts are functional and have been in place an average 4.4 months (range: 1 to 14 mo.). Acceptance by patients and particularly by personnel in the out-patient chemotherapy unit has been enthusiastic. Vascular access grafts can be inserted safely and provide a convenient route for drawing blood samples, and for administering chemotherapy and intermittent intravenous therapy in selected patients with neoplastic disease.