Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives.
Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives.
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DOI：
10.2147/vhrm.s205130
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发表时间：
2021
影响因子：
2.9
通讯作者：
Tozzi M
中科院分区：
文献类型：
--
作者：
Pirozzi N;Mancianti N;Scrivano J;Fazzari L;Pirozzi R;Tozzi M
非优势臂的自体桡侧-头侧直接腕部动静脉瘘（RC-AVF）是透析血管通路的金标准。然而，由于老年人和共病人群的发病率日益增加，RC-AVF未成熟率显著（约40%）。详细识别动静脉瘘（AVF）成熟背后的生物级联可能是旨在识别原发性AVF失败风险患者组的临床研究的关键。目前，仔细的术后监测仍然是克服成熟受损问题的最关键方面。高达80%的未成熟RC-AVF患者存在通过早期血管内或手术矫正可能解决的问题。由经验丰富的医生进行的体格检查结合双功能超声检查（DUS）可以识别未成熟的体征，了解根本原因，并制定针对性的早期计划来治疗并发症。AVF成熟早期评估的新方法正在研究中。到目前为止，通过术前或围手术期药物给药促进RC-AVF成熟的技术未能证明改善瘘成功率的有效性。手术后测试的新技术似乎为改善瘘管成熟提供了未来的希望。
Autogenous radial–cephalic direct wrist arteriovenous fistula (RC-AVF) in the non-dominant arm is the gold standard for dialysis vascular access. However, the RC-AVF non-maturation rate is significant (≃ 40%) due to an increasingly elderly and comorbid population incidence. A detailed identification of the biological cascade underlying arteriovenous fistula (AVF) maturation could be the key to clinical research aimed at identify the group of patients at risk of primary AVF failure. Currently, careful post-operative monitoring remains the most crucial aspect to overcome the problem of impaired maturation. Up to 80% of patients with immature RC-AVF have problems potentially solvable with early endovascular or surgical correction. Physical examination by experienced practitioners in conjunction with duplex ultrasound examination (DUS) can identify physical signs of non-maturation, understand the underlying cause, and drive for a tailored early planning to treat the complication. New approaches for the early assessment of AVF maturation are under study. Techniques to promote RC-AVF maturation performed through the administration of pre-or peri-operative drugs have missed up to now to prove an efficacy in improving fistula success. The new techniques tested after surgery appear to hold future promise for improving fistula maturation.