2022 年第 4 期 第 17 卷

人工血管动静脉内瘘单中心应用效果观察

Single-center observation on application of arteriovenous graft 

作者：黄巳悦王惠明

英文作者：Huang Siyue Wang Huiming

单位：武汉大学人民医院肾内科，武汉430060

英文单位：Department of Nephrology Renmin Hospital of Wuhan University Wuhan 430060 China

关键词：血管通路；人工血管动静脉内瘘；并发症；通畅率

英文关键词：Vascularaccess;Arteriovenousgraft;Complications;Patencyrate 

• 摘要：

• 目的 评价人工血管动静脉内瘘（AVG）的适用人群和临床应用效果。方法 回顾性分析武汉大学人民医院2017年1月至2021年6月建立自体动静脉内瘘（AVF）、AVG和中心静脉导管（CVC）进行血液透析的患者，分别纳入AVF组、AVG组和CVC组。比较3组患者临床特征的差异，并对AVG术后通畅率、术后并发症及干预措施进行随访和分析。结果 AVG组、AVF组、CVC组最终分别纳入64、138、88例患者。AVG组既往血液透析比例、使用过AVF通路比例高于AVF组和CVC组［87.5%(56/64)比31.9%(44/138)、69.3%(61/88)，57.8%(37/64)比14.5%(20/138)、34.1%(30/88)］，透析龄长于AVF组和CVC组［25(6,62)个月比0(0,12)、15(0,48)个月］（均P＜0.05）。AVG组术后初级通畅率低于CVC组（Long-rank P=0.020），2组术后次级通畅率差异无统计学意义（Long-rank P=0.050）。AVG术后并发症中常见狭窄和血栓，发生率分别为0.627例次/患者年和0.415例次/患者年，总并发症发生率为1.254例次/患者年。狭窄最常用的干预方式为球囊扩张术，发生率为0.425例次/患者年。血栓最常用的干预方式为经皮血栓清除术，发生率为0.361例次/患者年。结论 AVG适用于自身血管条件不佳、透析龄长、自身血管耗竭的患者。虽然AVG并发症发生率及术后再干预率较高，但具有较高的次级通畅率，可有效延迟或避免CVC的应用。

• Objective To investigate applicable population and clinical efficacy of arteriovenous graft (AVG). Methods From January 2017 to June 2021, patients who underwent arteriovenous fistula (AVF), AVG and central venous catheter(CVC) to hemodialysis in Renmin Hospital of Wuhan University were retrospectively analyzed. The clinical characteristics were compared among the three groups, and the patency, complications and reinterventions after AVG were followed-up and analyzed. Results In this study, 64, 138 and 88 patients were included in AVG group, AVF group and CVC group, respectively. The proportion of previous hemodialysis and the proportion of using AVF pathway in AVG group were higher than those in AVF group and CVC group［87.5%(56/64) vs 31.9%(44/138), 69.3%(61/88); 57.8%(37/64) vs 14.5%(20/138), 34.1%(30/88)］, and the dialysis age in AVG group was longer than that in AVF group and CVC group［25(6,62)months vs 0(0,12), 15(0,48)months］ (all P＜0.05). The primary patency rate after operation in AVG group was lower than that in CVC group (Long-rank P=0.020), but there was no significant difference in secondary patency rate between the two groups(Long-rank P=0.050). Stenosis and thrombosis were common complications after AVG, with the incidence of 0.627 per patient-year and 0.415 per patient-year respectively, and the total complication rate was 1.254 per patient-year. The most common intervention method for stenosis was balloon dilatation, with the incidence of 0.425 per patient-year. The most common intervention method for thrombosis was percutaneous thrombectomy, with the incidence of 0.361 per patient-year. Conclusions AVG is suitable for patients with poor vascular conditions, long-term dialysis and depletion of blood vessels. Although the rates of complication and reintervention are high, AVG has a high secondary patency rate, which may indeed delay or avoid the application of CVC.