Seminars in Vascular Surgery最新文献

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Choice of dialysis access: Catheter, peritoneal, or hemodialysis 透析途径的选择：导管、腹膜或血液透析。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.09.003

Andrea Lubitz , Karen Woo

The most recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines shifted emphasis to kidney replacement modality selection and vascular access planning and creation of the Endstage Kidney Disease Life-Plan, which promotes a patient-centered approach. The Life-Plan is intended to be created through discussions between the patient and their multidisciplinary care team to ultimately develop a lifelong kidney replacement therapy strategy. The focus of the Life-Plan is to engage the patient in a multidisciplinary patient-centered approach. The Life-Plan includes selection of the most suitable treatment modality (eg, hemodialysis, peritoneal dialysis, or transplantation), setting (home or center), and type of vascular access. Ultimately, this approach considers overall patient health, preferences, and anatomic factors. Patients choose between hemodialysis, which can be performed either in center or at home, and peritoneal dialysis. When considering vascular access, options consist of tunneled dialysis catheter, arteriovenous fistula, and arteriovenous graft. Each modality and vascular access type has benefits and disadvantages that should be weighed carefully with the patient and their supportive team to arrive at a decision that aligns as closely as possible with each individual patient's circumstances.

最新的国家肾脏基金会肾脏疾病结果质量倡议指南将重点转移到肾脏替代方式的选择和血管通路规划以及终末期肾脏疾病生命计划的创建，这促进了以患者为中心的方法。生命计划旨在通过患者和他们的多学科护理团队之间的讨论来制定最终的终身肾脏替代治疗策略。生命计划的重点是使患者参与以患者为中心的多学科方法。生命计划包括选择最合适的治疗方式（如血液透析、腹膜透析或移植）、环境（家庭或中心）和血管通路类型。最终，这种方法考虑了患者的整体健康、偏好和解剖因素。患者可以在血液透析（可在中心或家中进行）和腹膜透析之间进行选择。当考虑血管通路时，选择包括隧道透析导管、动静脉瘘和动静脉移植物。每种方式和血管通路类型都有利弊，应与患者及其支持团队仔细权衡，以尽可能根据每个患者的具体情况做出决定。

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引用次数: 0

The effects of hemodialysis on the cardiovascular system 血液透析对心血管系统的影响。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.001

Zachary S. Pallister, Jayer Chung

Chronic kidney disease and dialysis-dependent end-stage renal disease are increasing in prevalence in the United States. The costs associated with end-stage renal disease management comprise approximately 1% of the federal government's annual budget. Chronic kidney disease and end-stage renal disease cause significant derangements of the cardiac and vascular system. Pathophysiologic hallmarks include alterations of the renin–angiotensin system, chronically increased sympathetic tone, calcium and phosphate imbalance, pro-inflammatory cytokine release, and uremic toxin accumulation. This results in several pathologies specific to the cardiac and vascular systems, which will each be reviewed separately herein.

慢性肾脏疾病和透析依赖性终末期肾脏疾病在美国的患病率正在上升。与终末期肾脏疾病管理相关的费用约占联邦政府年度预算的1%。慢性肾脏疾病和终末期肾脏疾病引起心脏和血管系统的严重紊乱。病理生理特征包括肾素-血管紧张素系统的改变，长期增加交感神经张力，钙和磷酸盐失衡，促炎细胞因子释放和尿毒症毒素积累。这导致几种特定于心脏和血管系统的病理，这将在这里分别进行审查。

引用次数: 0

Tunneled dialysis catheter: Simple, re-do, complicated 隧道式透析导管：简单、重做、复杂

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.009

Ehab Sorial , Mrinal Shukla

Tunneled dialysis catheter (TDC) placement plays an essential role in hemodialysis patients. These catheters are inserted in a significant number of patients prior to establishing permanent dialysis access. Insertion is often simple and straightforward, and the preference is to use the right internal jugular vein due to fewer chances of long-term complications. However, significant obstacles exist including upper body central venous occlusions making catheter insertion complicated. In this report, we describe the technique of TDC insertion in the upper body, known complications from long-term TDC insertion, upper body central venous occlusion as an obstacle for TDC placement as well as the solutions available to mitigate this problem. Additionally, we will review techniques to convert TDC into long-term hemodialysis access.

隧道透析导管（TDC）的放置在血液透析患者中起着至关重要的作用。在建立永久性透析通道之前，这些导管被插入大量患者体内。插入通常简单直接，首选使用右颈内静脉，因为长期并发症的机会较少。然而，存在较大的障碍，包括上半身中心静脉阻塞，使导管插入变得复杂。在这篇报告中，我们描述了TDC在上半身的置入技术，已知的长期TDC置入的并发症，上半身中心静脉阻塞作为TDC置入的障碍，以及缓解这一问题的解决方案。此外，我们将回顾将TDC转化为长期血液透析通路的技术。

引用次数: 0

Management of carotid disease in the end-stage renal disease patient 终末期肾病患者的颈动脉疾病管理。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.09.002

Ali AbuRahma, Zachary AbuRahma

Chronic kidney disease (CKD) has been increasing in incidence as a result of the growing prevalence of diabetes and other risk factors for cardiovascular disease. This study highlights reports related to management of carotid disease in patients with CKD, with a special emphasis on end-stage renal disease (ESRD). Several earlier studies found that patients with CKD are more likely to die from cardiovascular causes than progress to ESRD requiring dialysis. Data derived from the US Renal Data System showed that the 30-day stroke/death rate was 10% after carotid endarterectomy and 11% after carotid artery stenting in patients on dialysis, with a median postoperative survival of 2.5 years. However, these data were representative of a patient cohort from 2005 to 2008. In the past 2 decades, significant life expectancy gains have been noted for patients with ESRD. Recent studies reported adjusted mortality has decreased by 20% in patients on hemodialysis and 29% in patients who underwent transplantation. In addition, recent studies have found that among patients with CKD, carotid endarterectomy and transcarotid artery revascularization had stroke/death rates of <2% for asymptomatic patients and <3% for symptomatic patients. Based on studies published to date, the risk of carotid intervention, whether carotid endarterectomy or stenting, specifically transcarotid artery revascularization, can be justified for carefully selected symptomatic patients with severe CKD with acceptable operative risk and good long-term life expectancy. However, patients with asymptomatic carotid disease and severe CKD, specifically ESRD, should be offered best optimal medical therapy unless life expectancy exceeds what has been recommended by recent Society for Vascular Surgery carotid guidelines.

由于糖尿病和其他心血管疾病风险因素的发病率不断增加，慢性肾脏病（CKD）的发病率也在不断上升。本研究重点介绍了有关 CKD 患者颈动脉疾病管理的报告，特别强调了终末期肾病 (ESRD)。早期的几项研究发现，慢性肾脏病患者更有可能死于心血管疾病，而不是发展为需要透析的 ESRD。来自美国肾脏数据系统的数据显示，透析患者颈动脉内膜剥脱术后 30 天的中风/死亡率为 10%，颈动脉支架术后 30 天的中风/死亡率为 11%，术后中位生存期为 2.5 年。不过，这些数据仅代表 2005 年至 2008 年期间的患者队列。在过去的 20 年中，ESRD 患者的预期寿命显著延长。最近的研究报告显示，血液透析患者的调整后死亡率下降了 20%，接受移植手术的患者的调整后死亡率下降了 29%。此外，最近的研究发现，在慢性肾脏病患者中，颈动脉内膜剥脱术和经颈动脉血运重建术的中风/死亡率为

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引用次数: 0

Management of thrombosed or failed dialysis access 处理血栓形成或失效的透析通路。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.006

Stephen N. Dalton-Petillo, Jeffrey J. Siracuse

Hemodialysis (HD) access for patients with end-stage renal disease is a steadily increasing necessity, and maintaining patency of native or synthetic fistulas can be challenging. The main physiologic changes of an HD access that cause it to fail are inflow or outflow vessel stenosis or access thrombosis. These are propagated by factors intrinsic to end-stage renal disease, altered hemodynamics from a fistula, and typically further exacerbated by associated comorbidities. Diagnosis of fistula dysfunction can be made with a combination of history, physical examination, HD dynamic measurements, laboratory findings, and invasive or noninvasive imaging. Stenoses can be managed with endovascular interventions, including angioplasty with or without stenting, or open operations. Thrombosis of HD access, which is most often a result of an underlying stenosis, can be managed similarly with either endovascular or surgical thrombectomy with adjunctive treatment. Our goal was to review the pathophysiology of the most common forms of fistula failure, diagnosis, and endovascular and surgical options for flow restoration.

为终末期肾病患者提供血液透析（HD）通路的必要性与日俱增，而保持原生或合成瘘管的通畅则极具挑战性。导致血液透析通路失效的主要生理变化是流入或流出血管狭窄或通路血栓形成。终末期肾病的内在因素、瘘管造成的血液动力学改变以及相关合并症通常会进一步加剧这些变化。瘘管功能障碍的诊断可结合病史、体格检查、高清动态测量、实验室检查结果以及有创或无创影像学检查。瘘管狭窄可通过血管内介入治疗（包括支架或不支架的血管成形术）或开放手术进行处理。HD 通路的血栓形成最常见的原因是潜在的狭窄，可通过血管内或外科血栓切除术及辅助治疗进行类似处理。我们的目标是回顾最常见瘘管失败形式的病理生理学、诊断以及恢复血流的血管内和外科手术方案。

引用次数: 0

Review of maintenance and surveillance of dialysis access 透析途径维持和监测的审查。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.008

Shayna Brathwaite , Amber B. Kernodle , Nader N. Massarweh , Olamide Alabi

Vascular access is an essential component of the Patient Life-Plan, Access Needs for patients with end-stage kidney disease requiring kidney replacement therapy with hemodialysis. Central venous catheter use is associated with high morbidity and mortality. As such, arteriovenous access (AVA) is the preferred modality for hemodialysis. Although AVA is preferred, maturation and functional patency after creation can be a challenge to achieve. A significant proportion of AVAs fail to mature, require reinterventions to achieve maturation, or cannot be successfully cannulated and used reliably for hemodialysis, despite physiologic maturation. Thus, most patients on hemodialysis require multiple AVA procedures throughout their lifetime. A thoughtful and deliberate strategy to create, maintain, survey, and troubleshoot AVA is required. In this review, autogenous AVA maturation, maintenance, and surveillance strategies to prolong the life of AVA for patients requiring hemodialysis are discussed.

血管通路是患者生命计划的重要组成部分，对于需要血液透析肾脏替代治疗的终末期肾脏疾病患者的通路需求。中心静脉导管的使用与高发病率和死亡率相关。因此，动静脉通路（AVA）是血液透析的首选方式。虽然AVA是首选，但创面后的成熟和功能通畅可能是一个挑战。很大比例的ava不能成熟，需要重新干预才能成熟，或者尽管生理成熟，但不能成功插管并可靠地用于血液透析。因此，大多数血液透析患者在其一生中需要多次AVA手术。需要一个深思熟虑的策略来创建、维护、调查和排除AVA的故障。在这篇综述中，讨论了自体AVA成熟、维持和监测策略，以延长需要血液透析的患者AVA的生命。

引用次数: 0

Effects of dialysis on peripheral arterial disease 透析对外周动脉疾病的影响。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.09.001

Sean C. Liebscher, Daniel J. Bertges

End-stage renal disease is an independent risk factor for the development of peripheral arterial disease, with considerably worse outcomes in patients with concomitant diseases. It is important to realize the widespread, yet frequently asymptomatic, nature of peripheral arterial disease in patients with end-stage renal disease due to the presence of other comorbidities that decrease activity levels and sensation to allow for early recognition and timely medical management to try and mitigate otherwise poor outcomes. Despite their high risk, properly selected patients derive benefit from revascularization; both open and endovascular approaches provide similar outcomes in terms of overall survival, amputation-free survival, and limb salvage, with perhaps a slight preference toward open repair. This narrative review of the literature evaluates the epidemiology, pathophysiology, outcomes, and management strategies that provide the best possible outcomes for patients with peripheral arterial disease and end-stage renal disease.

终末期肾病是发生外周动脉疾病的独立危险因素，并发症患者的预后更差。重要的是要认识到终末期肾病患者的外周动脉疾病非常普遍，但却常常没有症状，这是因为患者还存在其他合并症，这些合并症会降低患者的活动水平和感觉，因此必须及早识别并及时进行医疗管理，以尽量减轻其他不良后果。尽管风险很高，但经过适当选择的患者仍能从血管再通手术中获益；在总体存活率、无截肢存活率和肢体挽救率方面，开放式和血管内方法都能提供相似的结果，但开放式修复可能略胜一筹。这篇文献综述对流行病学、病理生理学、治疗效果以及为外周动脉疾病和终末期肾病患者提供最佳治疗效果的管理策略进行了评估。

引用次数: 0

Management of dialysis access in the post-transplantation patient 移植后患者透析通路的管理。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.005

Lindsay Lynch, Kevin Chang, Ashlee Stutsrim, Maureen Sheehan, Matthew Edwards

Arteriovenous fistula (AVF) is the preferred access for hemodialysis in patients with end-stage renal disease, and arteriovenous grafts are used when AVF creation is not feasible. Post renal transplantation, hemodialysis may be needed due to delayed graft function or transplantation failure. This review aimed to summarize current evidence on the impact of maintaining versus ligating AV access on renal function and cardiovascular outcomes post transplantation. A comprehensive review of literature was conducted, analyzing studies on the effects of AVF and AV graft maintenance or ligation on renal and cardiovascular outcomes in patients post transplantation. Evidence indicates that maintaining AVF post transplantation is associated with higher estimated glomerular filtration rate and better renal function retention, but poses risks for cardiovascular complications, such as left ventricular hypertrophy. Ligation of AVF is linked to improved cardiovascular outcomes, including reduced N-terminal pro-B-type natriuretic peptide levels, but may lead to a greater decline in estimated glomerular filtration rate. No significant difference in long-term renal allograft survival was observed between maintaining and ligating AV access. The decision to maintain or ligate AV access in patients post renal transplantation should be individualized, considering both renal function preservation and cardiovascular health. Although maintaining AVF may benefit renal function, it poses cardiovascular risks, whereas ligation can mitigate these risks without significantly affecting allograft survival.

动静脉瘘（AVF）是终末期肾病患者血液透析的首选途径，当动静脉瘘无法形成时，可以使用动静脉移植物。肾移植后，由于移植物功能延迟或移植失败，可能需要血液透析。本综述旨在总结目前关于维持与结扎房室通路对移植后肾功能和心血管结局影响的证据。我们对文献进行了全面的回顾，分析了AVF和AV移植维持或结扎对移植后患者肾脏和心血管预后的影响。有证据表明，移植后维持AVF与较高的肾小球滤过率和更好的肾功能保留有关，但存在心血管并发症的风险，如左心室肥厚。AVF结扎与心血管预后改善有关，包括降低n端前b型利钠肽水平，但可能导致肾小球滤过率估计的更大下降。维持和结扎房室通路对同种异体肾移植的长期存活率无显著差异。肾移植后患者维持或结扎房室通路的决定应个体化，同时考虑肾功能和心血管健康。尽管维持AVF可能有利于肾功能，但它会带来心血管风险，而结扎可以减轻这些风险，而不会显著影响同种异体移植物的存活。

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引用次数: 0

Peritoneal dialysis catheter insertion and maintenance 腹膜透析导管的插入和维护。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.002

James J. Wynn

The treatment of end-stage kidney disease (ESKD with peritoneal dialysis (PD) continues to increase. Timely initiation of PD is dependent on successful PD catheter placement, which can be performed using open or laparoscopic surgical or percutaneous techniques. Dialysis access surgeons who incorporate PD catheter insertion in their practice can uniquely offer comprehensive access services to their patients. This review discusses the various methods of PD catheter insertion, patient conditions that impact surgical decision-making, and the management of catheter-related complications.

采用腹膜透析（PD）治疗终末期肾病（ESKD）的患者不断增加。腹膜透析的及时启动取决于腹膜透析导管的成功置入，可通过开腹或腹腔镜手术或经皮技术进行。将腹膜透析导管置入术纳入临床实践的透析通路外科医生可以为患者提供独一无二的综合通路服务。本综述讨论了插入 PD 导管的各种方法、影响手术决策的患者情况以及导管相关并发症的处理。

引用次数: 0

Alternatives for exhausted dialysis access 用尽透析通道的替代方案。

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semvascsurg.2024.10.003

Laura B. Pride, Edwyn J. Assaf, Lauren N. West-Livingston, Christina L. Cui, Tristen T. Chun, Chandler A. Long

Hemodialysis (HD) access failure is a frequent problem encountered by vascular surgeons. As treatment of end-stage renal disease improves and patients live longer on HD, eventual exhaustion of traditional upper extremity HD access is common. Efforts to preserve and maintain these accesses are essential. However, when they fail, alternative surgical access options should be pursued prior to destination-tunneled dialysis catheters. Hemodialysis Reliable Outflow grafts as well as various configurations of lower extremity arteriovenous fistulae and grafts can be utilized. For most alternative HD access options, there is a paucity of data for long-term patency, cost, and risk of infectious or ischemic complications compared to traditional options. However, smaller studies examining Hemodialysis Reliable Outflow grafts, femoral vein transposition, and lower extremity grafts show acceptable safety and efficacy. Depending on the cause of traditional access failure and patient-specific anatomic constraints, we recommend a systematic approach to alternative access creation, with destination-tunneled dialysis catheters reserved as a last resort. The most common cause of HD access failure is venous outflow obstruction. As such, we have structured this manuscript around a meta-analysis of retrospective studies describing nontraditional access options that can be utilized with escalating degrees of central venous stenosis or occlusion.

血液透析（HD）通路失败是血管外科医生经常遇到的问题。随着终末期肾病治疗的改善和HD患者寿命的延长，传统的上肢HD通道最终衰竭是很常见的。保护和维护这些通道的努力至关重要。然而，当它们失败时，应在目的隧道透析导管之前寻求其他手术通路选择。血液透析可靠的流出性移植物，以及各种配置的下肢动静脉瘘和移植物都可以使用。与传统方案相比，对于大多数替代HD接入方案，缺乏长期通畅、成本和感染或缺血性并发症风险的数据。然而，对血液透析可靠流出体移植物、股静脉转位和下肢移植物的小型研究显示出可接受的安全性和有效性。根据传统通路失败的原因和患者特定的解剖限制，我们建议采用一种系统的方法来创建替代通路，保留目的隧道透析导管作为最后的手段。HD通道失败最常见的原因是静脉流出梗阻。因此，我们围绕回顾性研究的荟萃分析构建了这篇论文，这些研究描述了可以用于中心静脉狭窄或闭塞程度不断升级的非传统通路选择。

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