Efficacy of the Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A Systematic Review
Efficacy of the Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A Systematic Review
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DOI：
10.1016/j.avsg.2015.09.027
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发表时间：
2016-04-01
影响因子：
1.5
通讯作者：
Inston, Nicholas
中科院分区：
文献类型：
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作者：
Al Shakarchi, Julien;Khawaja, Aurangzaib;Inston, Nicholas
背景：瘘管优先倡议促进了动静脉瘘（AVF）作为血管通路的选择。为了保留尽可能多的未来入路选择，多个指南主张首先应创建尽可能远的AVF。一般来说，鼻烟窝和桡头动脉（RC）是AVF的公认和良好描述的部位;然而，前臂尺-贵要动脉（UB）AVF很少使用或推荐。本研究的目的是评估和系统地审查的证据基础的UB瘘的创建和批判性地评价是否应该给予更多的关注，以这个site.Methods：电子数据库进行了搜索，研究涉及建立UB瘘透析按照系统评价和荟萃分析（PRISMA）的首选报告项目的指导方针。本研究的主要结局为1年一期和二期通畅率。次要结果是血液透析通路诱导的远端缺血（HAIDI）和infection.Results的比率：严格的纳入和/或排除标准后，由2名评论家，8项研究被纳入我们的审查。加权汇总数据显示UB AVF的1年一期通畅率为53.0%（95%置信区间[CI]：40.1-65.8%），二期通畅率为72.0%（95% CI：59.2-83.3）。HAIDI和感染率低。结论：我们的回顾表明，UB AVF可能是一个可行的替代时，RC AVF是不可能的，透析是不需要迫切。它具有足够的1年一期和二期通畅率，并且HAIDI风险极低。虽然对于外科医生和透析护士来说，使其成为成功的血管通路可能更具挑战性，但它提供了可能被忽视的远端通路的另一种选择。
Background: The fistula first initiative has promoted arteriovenous fistulas (AVFs) as the vascular access of choice. To preserve as many future access options as possible, multiple guidelines advocate that the most distal AVF possible should be created in the first place. Generally, snuff box and radiocephalic (RC) are accepted and well-described sites for AVFs; however, the forearm ulnar-basilic (UB) AVF is seldom used or recommended. The aim of this study is to assess and systematically review the evidence base for the creation of the UB fistula and to critically appraise whether more attention should be given to this site.Methods: Electronic databases Were searched for studies involving the creation of UB fistulas for dialysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes for this study were 1-year primary and secondary patency rates. Secondary outcomes were rates of hemodialysis access-induced distal ischemia (HAIDI) and infection.Results: After strict inclusion and/or exclusion criteria by 2 reviewers, 8 studies were included in our review. Weighted-pooled data reveal 1-year primary patency rate for UB AVFs of 53.0% (95% confidence interval [CI]: 40.1-65.8%) with a secondary patency rate of 72.0% (95% CI: 59.2-83.3). HAIDI and infection rates were low.Conclusions: Our review has shown that the UB AVF may be a viable alternative when a RC AVF is not possible, and dialysis is not required urgently. It has adequate 1-year primary and secondary patency rates and extremely low risk of HAIDI. While it may be more challenging for both surgeons and dialysis nurses to make it a successful vascular access it offers a further option of distal access which may be overlooked.