上肢远端vs近端动静脉造瘘对慢性肾衰竭患者维持性血液透析的影响

Dr. Mohammed Nadeem Nazim
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摘要

目的:目的是分享我们的经验,近端和远端类型的动静脉瘘(AVF),并确定一种优于另一种的优势,最终有更高的成功率。方法:所有转至CVTS科进行AVF构建的患者均进行详细的临床检查,以评估感兴趣上肢静脉系统的质量。所有腕部静脉质量差的患者或先前腕部AVF失败的患者在肘前窝接受近端A-V瘘。对术后即刻及后期手术并发症进行分析。这230例病例在12个月的时间里进行了定期随访和观察。结果:近端avf成熟失败率为5.21%,远端avf为13.0%,平均成熟时间分别为1.5个月和2-2.5个月。12个月时,近端avf的总通畅率为98%,远端avf的总通畅率为74%。结论:与远端AVF相比,MHD的近端a - v瘘成熟早,初级通畅率高,由于观察到的并发症和低成熟率,即使在手术8周后也只有可触及的脉搏,因此在未来无意中需要新的近端AVF。
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Distal vs proximal arterio venous fistula creation in the upper limb for maintenance hemodialysis in chronic renal failure patients
Purpose: The goal was to share our experience of the proximal and distal types of arteriovenous fistula (AVF) and to ascertain advantage of one over the other and ultimately which has a superior success rate. Methods: All patients referred to the department of CVTS, for construction of AVF underwent a detailed clinically examination to assess the quality of the venous system of the upper limb of interest. All patients with poor quality veins at the wrist or patients in whom previous AVF at the wrist had failed were taken up for proximal A-V fistula at the antecubital fossa. The surgical complications were analysed in the immediate and late postoperative period. These 230 cases were performed over a span of 12 months with regular follow up and observation for the next 12 months.Results: The proximal AVFs had only a 5.21% maturation failure cases as compared to the 13.0% in distal AVFs with mean time for maturation being 1.5 months and 2-2.5 months, respectively. The overall primary patency rates at 12 months were 98% for proximal AVFs and 74% for distal AVFs.Conclusion: The Proximal A-V fistulas for MHD were found to have early maturation and high primary patency rates in comparison to the distal AVFs which inadvertently required new proximal AVF creation in the future due to the observed complications and low maturation rates with only a palpable pulse even after 8 weeks of surgery.
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