中国血液净化 ›› 2019, Vol. 18 ›› Issue (09): 635-638.doi: 10.3969/j.issn.1671-4091.2019.09.014

• 血管通路 • 上一篇    下一篇

即穿型人工血管动静脉内瘘的初步应用

葛玮婧1,鲍雪东1,胡婧伊1,刘思洁1,王世超1,施娅雪1   

  1. 1. 上海中医药大学附属龙华医院血管外科
  • 收稿日期:2019-02-15 修回日期:2019-06-26 出版日期:2019-09-12 发布日期:2019-09-02
  • 通讯作者: 施娅雪drshiyaxue@163.com E-mail:drshiyaxue@163.com
  • 基金资助:
    即穿型人工血管在血液透析通路中的应用(18LK032)

Clinical application of early cannulation graft for arteriovenous fistula

  1.  1Department of Vascular Surgery, LongHua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
  • Received:2019-02-15 Revised:2019-06-26 Online:2019-09-12 Published:2019-09-02

摘要: 【摘要】目的总结GORE® ACUSEAL 即穿型人工血管动静脉内瘘的初步临床应用结果。方法回顾性分析笔者在2016 年12 月~2018 年9 月收治的37 例GORE® ACUSEAL 即穿型人工血管动静脉瘘的临床资料,总结其首次穿刺时间、通畅率及并发症的发生率。结果本组男13 例,女24 例,平均年龄(62.30±10.24)岁,建立上肢即穿型人工血管(arteriovenous graft,AVG)31 例,下肢6 例。手术成功率100%,无围手术期并发症。术后首次穿刺时间14h~42d,平均穿刺时间(84.26±172.56)h。穿刺相关皮下血肿3例。平均随访时间(299.0±141.3)d,随访率100%,血栓10 例,狭窄6 例,感染2 例,局部皮肤坏死2 例,死亡2 例,无血清肿、假性动脉瘤、窃血综合征发生。半年及1 年初级通畅率分别为65.1%±8.2%和46.9%±10.1%,初级辅助通畅率分别为76.8%±7.2%和69.6%±8.2%,1 年次级通畅率为94.6%±3.7%。结论即穿型人工血管术后可立刻穿刺,避免过渡期中心静脉置管,缩短了导管的留置时间,在临床有一定的应用价值。

关键词: 血管通路, 即穿型人工血管, Acuseal

Abstract:

【Abstract】Objectives To evaluate the preliminary clinical outcome of early cannulation graft for arteriovenous fistula. Methods Thirty-seven cases with the early cannulation type graft (GORE® Acuseal) for arteriovenous fistula in the period from December 2016 to September 2018 were retrospectively analyzed. Their clinical data, the first cannulation time, patency and complications were summarized. Results There were 13 males and 24 females with an average age of 62.30+10.24 years. Thirty- one cases were in upper limbs and 6 cases in lower limbs. The success rate of the operation was 100%, and no perioperative complications happened. The first cannnulation time ranged from 14 hours to 42 days with an average cannulation time of 84.26+172.56 hours. Puncture-related subcutaneous hematoma was found in 3 cases. Mean follow-up period was 299.0±141.3 days with the follow-up rate of 100%. Thrombosis was found in 10 cases, stenosis in 6 cases, infection in 2 cases, and necrosis of local skin in 2 cases. Two cases died. No seroma, pseudoaneurysm or stealing syndrome occurred. The primary patency rates after 6 months and one year were 65.1%±8.2% and 46.9%±10.1% respectively; the primary assisted patency rates after 6 months and one year were 76.8%±7.2% and 69.6%±8.2% respectively; the secondary patency rate after one year was 94.6%±3.7%. Conclusions Early cannulation type of graft has the advantage of immediate cannulation after operation, avoiding central venous catheterization in transitional period or shortening the catheterization period. This type of graft is useful for clinical application.

Key words: Vascular access, Early cannulation graft, Acuseal

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