Permanent vascular access: a nephrologist's view.
Permanent vascular access: a nephrologist's view.
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永久血管通路：肾病专家的观点。
DOI：
10.1016/s0272-6386(12)80391-x
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Windus,DW
中科院分区：
文献类型：
--
作者：
Windus,DW
血管通路并发症是美国血液透析患者发病率的最大原因。虽然动静脉瘘已被推荐为血管通路的首选方式，但最近的数据表明，在美国，大多数血液透析患者都有假体移植物瘘。假体移植物瘘最常见的并发症是血栓形成和狭窄。糖尿病和黑人患者的瘘管并发症住院率较高。血管内膜增生的发病机制可能包括血小板衍生生长因子的分泌和内皮细胞的机械性损伤。瘘管狭窄和血流受损的筛查可以通过再循环测量、静脉和通路内压力测量以及多普勒超声进行。这些技术的结合可能是目前筛查和进一步评估瘘管的最佳策略。手术取栓和瘘管翻修仍然是比较新的并发症处理方法的标准。无论有无支架置入、溶栓和使用动脉粥样硬化装置，经皮血管成形术在并发症的治疗中可能发挥越来越大的作用，尽管这些方式需要进行对比试验。对于移植物动静脉瘘，尚无令人满意的预防血栓形成、狭窄或再狭窄的长期药理学方法。希望血管通路放置和管理领域的未来方向将包括允许原发动静脉瘘发展的更好的策略，移植物材料的进展，对血栓形成和狭窄的发病机制的更好的了解，以及预防并发症的开发策略。
Vascular access complications are the greatest cause of morbidity in hemodialysis patients in the United States. Although arteriovenous fistulas have been recommended as the preferred mode of vascular access, recent data indicate that the majority of patients on hemodialysis in the United States have prosthetic graft fistulas. The most frequent complications of prosthetic graft fistulas are thrombosis and stenosis. Hospitalization rates for fistula complications are higher in patients with diabetes mellitus and of black race. Pathogenesis of intimal hyperplasia may include elaboration of platelet-derived growth factor and mechanical endothelial injury. Screening for stenosis and impaired blood flow in fistulas can be carried out with recirculation measurements, venous and intra-access pressure measurements, and Doppler ultrasound. A combination of the techniques is probably the best current strategy for fistula screening and further evaluation. Surgical thrombectomy and fistula revision remain the standard for comparison of newer approaches to management of complications. Percutaneous angioplasty with or without stent placement, thrombolysis, and use of atherectomy devices may play an increasing role in the treatment of complications, although comparative trials of these modalities need to be performed. No satisfactory long-term pharmacologic means of preventing thrombosis, stenosis, or restenosis have been found for graft arteriovenous fistulas. It is hoped that future directions in the field of vascular access placement and management will include better strategies for allowing primary arteriovenous fistula development, advances in graft materials, improved understanding of the pathogenesis of thrombosis and stenosis, and development strategies to prevent complications.