Prosthetic Arteriovenous Grafts for Hemodialysis
Prosthetic Arteriovenous Grafts for Hemodialysis
复制标题
用于血液透析的人工动静脉移植物
DOI：
10.1177/112972980901000301
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
J. Akoh
中科院分区：
文献类型：
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作者：
J. Akoh
简介 人工动静脉 (AV) 移植物适用于 AV 瘘 (AVF) 失败、浅静脉衰竭或血管不合适的患者。增加使用自体 AVF 的血液透析 (HD) 患者比例应减少对 AV 移植物的需求和相关发病率。本文综述了目前人工 AV 移植物在 HD 血管通路中的作用。技术考虑 在插入假体 AV 移植物之前，除了血管测绘之外，还需要对之前的进入程序进行全面审查并进行全面的体检。吻合技术应考虑血流扩散器概念、移植物几何形状和 15° 吻合角，以减少内膜增生的发生率。结果 许多作者报告称，1 年和 2 年累积移植物通畅率分别为 59-90% 和 50-82%。合成移植物的主要缺点包括：血栓形成、感染风险增加五倍以及盗窃综合症。尽管经皮技术正在发挥越来越重要的作用，但手术和经皮方法治疗房室移植物阻塞的选择仍然存在争议。经皮策略在 67-95% 的病例中成功解除血栓。血栓切除术后狭窄病变的支架置入可提高二次通畅率。处理 AV 移植物感染的策略包括抗生素预防、部分、次全或全部移植物切除以及使用生物假体。结论 虽然 AV 移植物比自体 AVF 更容易出现并发症，但成熟期短，并且更适合通过放射或手术手段进行血栓切除术。复杂的 AV 移植物可能适合入路部位耗尽的患者。
Introduction Prosthetic arteriovenous (AV) grafts are indicated in patients with failed AV fistula (AVF), exhausted superficial veins or unsuitable vessels. Increasing the proportion of prevalent hemodialysis (HD) patients using autogenous AVF should reduce the need for AV grafts and associated morbidity. This paper reviews the current role of prosthetic AV grafts in vascular access for HD. Technical considerations Prior to the insertion of a prosthetic AV graft, a comprehensive review of previous access procedures and full physical examination in addition to vessel mapping is required. Anastomotic technique should take into account the flow diffuser concept, graft geometry and an anastomotic angle of 15° in order to reduce the incidence of intimal hyperplasia. Results Many authors report 1 and 2-yr cumulative graft patency rates of 59–90% and 50–82%, respectively. The major drawbacks with synthetic grafts include: thrombosis, a five-fold increase in infection risk and steal syndrome. The choice between surgical and percutaneous methods of dealing with blocked AV grafts remains controversial, though percutaneous techniques are assuming an increasingly important role. Percutaneous strategies are successful in declotting access in 67–95% of cases. Stenting of stenotic lesions following thrombectomy improves secondary patency rates. Strategies for dealing with AV graft infection include antibiotic prophylaxis, partial, subtotal or total graft excision and the use of biological prosthesis. Conclusions Though more prone to complications than autogenous AVFs, AV grafts offer a short maturation period and are more amenable to thrombectomy by radiological or surgical means. Complex AV grafts may be appropriate in patients with exhausted access sites.
用于困难的血液透析通路的腋窝-腋窝环移植物
DOI：
--
发表时间：
2019
期刊：
影响因子：
--
作者：
Atsuko Uema;Yasushi Matsushita;Asuka Ueno;Riha Shimizu;Yuki Nakatani;Takanori Yasu
通讯作者：
Takanori Yasu
影响因子：
120.7
作者：
Dember, Laura M.;Beck, Gerald J.;Feldman, Harold I.
通讯作者：
Feldman, Harold I.