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血液透析接入并发症的诊断和管理:一篇评论
Mikayla Hurwitz1, Quynh-Anh Dang2, Salvatore Scali3
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
JAMA surgery
|November 5, 2025
概括
动脉静脉 (AVF) 和移植 (AVG) 对于血液透析的准入至关重要. 了解和管理他们的并发症对于患者的生存和保持长寿至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 血管外科 血管外科
- 干预性放射学 干预性放射学
背景情况:
- 在美国,每年有超过10万名患者开始进行血液透析.
- 动脉静脉 (AVF) 是首选的透析访问由于耐用性和较低的并发症率.
- 假体动脉静脉移植 (AVG) 作为一个关键的替代方案,为患者与次优的自身选择.
研究的目的:
- 审查与动脉静脉 (AVF) 和动脉静脉移植 (AVG) 相关的常见并发症.
- 为这些访问类型突出基于证据的管理策略.
- 强调让外科医生和非外科医生熟悉AVF和AVG挑战的重要性.
主要方法:
- 审查关于AVF和AVG并发症的当前文献.
- 讨论诊断评估,包括病史,体检和双重成像.
- 分析治疗选择,从保守的管理到手术和内血管程序.
主要成果:
- 接入并发症可以表现为急性或慢性,模仿或加剧功能衰竭的结果.
- 常见的并发症包括手缺血 (斯蒂尔综合征),手掌道综合征,节神经病变,动脉瘤和伪动脉瘤.
- 对于诸如缺血性单分子神经病变,持续出血和高输出心力衰竭等并发症,需要紧急干预.
结论:
- 有效地管理AVF和AVG并发症对于保持长寿至关重要.
- 治疗决策必须与患者的并发症和解剖因素平衡.
- 了解诊断和治疗选择可以最大限度地降低与血液透析相关的发病率和死亡率.
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