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更有选择性的动脉静脉囊策略对血管接入结果的影响

Michael Allon¹, Alian Al-Balas¹, Carlton J Young²

¹Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.

Journal of the American Society of Nephrology : JASN

|July 4, 2023

概括

仔细选择患者进行动脉静脉囊 (AVF) 放置在血液透析减少程序和成本. 对于AVF创建的更有选择性的策略,与最大化放置相比,可以改善血管接入结果.

科学领域:

腎臟病學 (nephrology) 是一種醫學專業.
血管外科血管外科
医疗保健服务研究医疗服务研究

背景情况:

对于血液透析血管接入的动脉静脉 (AVF) 和动脉静脉移植 (AVG) 之间的最佳选择是有争议的,特别是对于从中央静脉导管 (CVC) 开始的患者.
之前的策略集中在最大限度地提高AVF的产生,这可能导致某些患者群体的不理想结果.

研究的目的:

为了比较一种不那么选择性的AVF创建策略的有效性和成本,与在用CVC启动血液透析的患者中采用更有选择性的方法进行比较.
评估这些策略对血管接入程序频率,管理成本和导管依赖的持续时间的影响.

主要方法:

一项实用观察性研究比较了两个时期:1期 (2004-2012) 采用了不那么有选择性的AVF策略,2期 (2013-2019) 采用了更有选择性的策略,避免了高风险的AVF安置.
该研究分析了692名患者的数据,比较了每个时期的结果,包括访问程序的频率,管理成本和AVF和AVG组之间的CVC依赖.

主要成果:

选择性策略 (2期) 导致AVF患者的访问程序减少,与AVG患者相比,AVF患者的访问管理成本年均中位数较低,与1期不同.
在第2期,AVF安置变得更为常见,但与第1期相比,总体平均年度访问管理成本显著下降.
与AVG相比,AVF在第1期减少了导管依赖的持续时间,在第2期观察到的差异较小.

结论:

对AVF安置的更有选择性的方法,避免具有高预测失败风险的病例,可以改善血管接入结果.
这种选择性策略减少了血管接入程序的频率,并降低了血液透析患者接入管理的总体成本.

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