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桡动脉-头静脉瘘因其通畅率高、并发症少而被认为是血液透析血管通路的第一选择,但高达50%的内瘘因各种原因不能成熟,这主要是由于持续性地低血流量或穿刺困难导致无法进行充分的血液透析。常见的原因有流入道或流出道狭窄、吻合口狭窄、静脉位置过深及分支静脉的分流。此外,血栓形成是造成狭窄的一个常见原因。术前通过体格检查和超声检查评估血管条件选择合适的血管对于内瘘的成熟有着重要的意义。应针对引起成熟障碍的病因选择合适的治疗方法:术后普遍应用阿司匹林预防血栓形成进而减少狭窄的发生;外科手术有绕过损伤区域的优点但却创造一个新的吻合;近年来血管腔内技术因其微创的特点在大多数时候是第一选择。本文将对内瘘成熟障碍的定义、病因、诊断及治疗进行综述。
Radial arteriovenous fistulas are considered the first choice of hemodialysis vascular access because of their high patency and few complications, but up to 50% of fistulas can not mature for a variety of reasons, primarily due to the persistently low Difficulty in blood flow or puncture leads to inadequate hemodialysis. Common causes of narrowing of the inflow or outflow tract, anastomotic stenosis, venous position is too deep and branch vein shunt. In addition, thrombosis is a common cause of stenosis. Preoperative assessment of vascular conditions by physical examination and ultrasound to select the appropriate blood vessels for the maturation of fistula is of great significance. Should choose the appropriate treatment for the etiology of the disorder caused by maturity: Aspirin is generally used to prevent thrombosis after surgery to reduce the occurrence of stenosis. Surgery has the advantage of bypassing the damaged area but it creates a new anastomosis. In recent years, intraluminal techniques Because of its minimally invasive features in most of the time is the first choice. This article will review the definition, etiology, diagnosis and treatment of obstructive fistula.