動靜脈瘻管是腎臟病人接受長期血液透析最常使用之血管通路

Arteriovenous Fistula: The Most Common Vascular Access of Renal Disease Patients on Long-term Hemodialysis

劉亮廷(Liang-Ting Liu)

《北市醫學雜誌》 14卷4期 (2017/12) Pp. 409-415

https://doi.org/10.6200/TCMJ.2017.14.4.01

摘要

台灣末期腎臟病的發生率和盛行率高居世界第一位，遠高於歐洲各國、美國和日本。當末期腎臟病患以血液透析作為長期之腎臟替代療法時，動靜脈瘻管是優先選擇之血管通路。所謂動靜脈瘻管是由心臟血管外科醫師將動脈和靜脈剝離出來後，再予以吻合完成的血管通路。大多數病患可於局部麻醉下進行手術。手術部位是以非慣用側上肢為首選。根據血管狀況，動靜脈瘻管可用自體血管或人工血管來建立。由於用自體或人工血管與動靜脈瘻管以後發生感染以及因狹窄或栓塞所導致的失能的機率有關，所以手術前的評估非常重要。最有效監測動靜脈瘻管功能的檢查是週邊動靜脈血管超音波檢查。一般建議每三個月定期接受檢查，以及早發現狹窄或栓塞病灶，儘快進行血管介入治療，避免動靜脈瘻管發生失能，以維持暢通性和良好的生活品質。

關鍵字

末期腎臟病 ； 血液透析 ； 動靜脈瘻管

並列摘要

The incidence and prevalence of end stage renal disease in Taiwan ranks the first in the world, and far ahead of European countries, the United States and Japan. When the end stage renal disease patients accept hemodialysis as the long-term renal replacement therapy, a surgery for vascular access is needed and arteriovenous fistula is the primary choice. Arteriovenous fistula is constructed by a cardiovascular surgeon. The procedures include dissection of an artery and a vein followed by the creation of anastomosis between them, directly or indirectly with a synthetic vascular graft. Most patients can tolerate the surgery under local anesthesia. The ideal site of an arteriovenous fistula is the non-dominant upper limb. Owing to the difference of infection rate and dysfunction resulting from stenosis or thrombosis between autologous arteriovenous fistula and synthetic arteriovenous shunt, the preoperative evaluation of the blood vessels is of critical importance. The most effective tool for preoperative evaluation and postoperative follow-up is the vascular duplex examination, which can identify any stenotic or thrombotic lesion to allow intervention in time to maintain the patency of the arteriovenous fistula. We recommend a vascular duplex examination of arteriovenous fistula every three months. An arteriovenous fistula is the lifeline to end stage renal disease patients. Its quality and patency is crucial to the quality of life of them.

並列關鍵字

End stage renal disease ； hemodialysis ； arteriovenous fistula