TITLE: Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages.

INTRODUCTION:The main objective of the present study is to investigate the advantages and disadvantages of proximal arteriovenous native fistulas. Hemodialysis is indispensable for patients with end-stage renal disease. For this purpose, arteriovenous fistulas (AVFs) are used. Among the native fistulas, distal radiocephalic AVF is the most preferred. However, brachiocephalic AVF (BCAVF) and brachiobasilic AVF with basilic vein transposition (basilic vein transposition arteriovenous fistula [BVTAVF]) can be used for a long time in dialysis patients whose distal vascular bed is depleted.

METHODS:This is a retrospective study of 117 AVFs (BCAVF and BVTAVF), in patients with end-stage chronic renal disease, that were opened with a surgical technique (2012-2018). The postoperative two-year patency rates, AVF locations, complications, and the advantages and disadvantages of these fistulas are reviewed and recorded in the light of the literature.

RESULTS:The mean age of the patients (52 men and 65 women) was 60.6 ± 13.6 years. The percentages of primary patency rates at 3, 6, 9, 12, and 24 months were 96.6%, 93.1%, 92%, 87.4%, and 82.8% in BCAVF patients, and 96.7%, 93.3%, 90%, 86.7%, and 80% in BVTAVF patients, respectively. The percentages of secondary patency rates at 6, 12, and 24 months were 100%, 93.3%, and 86.7% in BCAVF patients, and 100%, 100% and 87.7% in BVTAVF patients, respectively. Fistula thrombosis was seen as the most common complication. The early complication was bleeding/hematoma. As late complications, we encountered steal syndrome, ischemic pain in the relevant extremity, pseudoaneurysm, and high-output heart failure.

CONCLUSION:Proximal AVFs are preferable fistulas with early maturation and high primary patency rates. We believe that relatively high complications can be avoided by opening fistulas with an appropriate surgical technique.

SOURCE: Güven C, Uludağ Ö. Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages[J]. Cureus, 2020,12(11):e11657. DOI: 10.7759/cureus.11657.

引言：本研究的主要目的是研究近端自体动静脉内瘘的优缺点。血液透析治疗是终末期肾脏疾病患者不可或缺的治疗方式之一。为此，需要使用动静脉内瘘（AVF）。在自体内瘘中，最优选择远心端桡-头型AVF。但是，对于远端血管床已耗尽的透析患者，可以长期使用肱-头型AVF（BCAVF）和伴有贵要静脉转位的肱-贵要型AVF（贵要静脉转位动静脉内瘘[BVTAVF]）。

方法：这是一项对117例AVF（BCAVF和BVTAVF）的回顾性研究，研究对象是通过手术技术（2012-2018年）建立内瘘的终末期慢性肾脏病患者。根据文献回顾并记录术后两年的通畅率，AVF位置，并发症以及这些瘘管的优缺点。

结果：患者的平均年龄（52名男性和65名女性）为60.6±13.6岁。 BCAVF患者在3、6、9、12和24个月时的初次通畅率百分比分别为96.6％，93.1％，92％，87.4％和82.8％，BVTAVF患者分别为96.7％，93.3％，90％，86.7％和80％。 BCAVF患者在6、12和24个月时的二次通畅率分别为100％，93.3％和86.7％，BVTAVF患者分别为100％，100％和87.7％。内瘘血栓形成被认为是最常见的并发症。早期并发症为出血/血肿。在晚期并发症方面，我们遇到了盗窃综合症，相关肢体的缺血性疼痛，假性动脉瘤和高输出心力衰竭。

结论：近端（上臂）AVF是很好的瘘管，具有早熟和高通畅率的特点。我们认为，通过采用适当的手术方式建立瘘管可以避免相对较高的并发症。

启发：上臂动静脉内瘘的通畅率的确比较好，但是其高输出心力衰竭、头静脉弓狭窄、血栓/血肿形成等并发症都是不容忽视的。