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【J Vasc Surg】用于动静脉内瘘成型的的人工血管移

http://www.jvascsurg.org/article/S0741-5214(08)00631-9/abstract
Brachial artery ligation with total graft excision is a safe and effective approach to prosthetic arteriovenous graft infections
Presented at the Society for Clinical Vascular Surgery Annual Meeting, Orlando, Fla, Mar 21-24, 2007.

Andres Schanzer, MDa, Andrea L. Ciaranello, MD, MPHb, Harry Schanzer, MDc

Received 5 March 2008; accepted 10 April 2008. published online 24 June 2008.

Objective
While autogenous arteriovenous access is preferred, prosthetic arteriovenous grafts (AVG) are still required in a large number of patients. Infection of AVGs occurs frequently and may cause life-threatening bleeding or sepsis. Multiple treatment strategies have been advocated (ranging from graft preservation to excision with complex concomitant reconstructions), indicating a lack of consensus on appropriate management of infected AVGs. We undertook this study to evaluate if, in the setting of anastomotic involvement, brachial artery ligation distal to the origin of the deep brachial artery accompanied by total graft excision (BAL) is safe and effective.

Methods
All prosthetic arteriovenous graft infections managed by a single surgeon between 1995 and 2006 were reviewed retrospectively. Patients were identified from a computerized vascular registry, and data were obtained via patient charts and the electronic medical record.

Results
We identified 45 AVG infections in 43 patients. Twenty-one patients (49%) demonstrated arterial anastomotic involvement and were treated with BAL; these form the cohort for this analysis. Mean patient age was 53.2 (SD 9.5) years. The primary etiologies for end stage renal disease (ESRD) were hypertension (29%), HIV (24%), and diabetes (19%). An upper arm AVG was present in 95% of patients; one (5%) had a forearm AVG. The majority of grafts were polytetrafluoroethylene (PTFE) (90%). Follow-up was 100% at 1 month, 86% at 3 months, and 67% at 6 months. No ischemic or septic complications occurred in the 21 patients who underwent BAL.

Conclusion
BAL is an effective and expeditious method to deal with an infected arm AVG in frequently critically ill patients with densely scarred wounds. In the short term, BAL appears to be well tolerated without resulting ischemic complications. Further study with longer duration of follow-up is necessary to ascertain whether BAL results in definitive cure, or whether patients may ultimately manifest ischemic changes and require additional intervention. 本人已认领该文编译,48小时后若未提交译文,请其他战友自由认领。 Brachial artery ligation with total graft excision is a safe and effective approach to prosthetic arteriovenous graft infections
用于动静脉内瘘成型的的人工血管移植物感染后行肱动脉结扎并全移植物切除是安全和有效的
Presented at the Society for Clinical Vascular Surgery Annual Meeting, Orlando, Fla, Mar 21-24, 2007.
发表于临床血管外科年会 Orlando, Fla, Mar 21-24, 2007.
Andres Schanzer, MDa, Andrea L. Ciaranello, MD, MPHb, Harry Schanzer, MDc

Received 5 March 2008; accepted 10 April 2008. published online 24 June 2008.
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Objective
While autogenous arteriovenous access is preferred, prosthetic arteriovenous grafts (AVG) are still required in a large number of patients. Infection of AVGs occurs frequently and may cause life-threatening bleeding or sepsis. Multiple treatment strategies have been advocated (ranging from graft preservation to excision with complex concomitant reconstructions), indicating a lack of consensus on appropriate management of infected AVGs. We undertook this study to evaluate if, in the setting of anastomotic involvement, brachial artery ligation distal to the origin of the deep brachial artery accompanied by total graft excision (BAL) is safe and effective.
目的:虽然自身血管动静脉内瘘成型术更适合。但是目前仍有很多患者需要接受人工血管动静脉内瘘成型术(AVG)。但是AVG容易发生出血和脓毒症而威胁患者生命。为此外科医师采取了包括保留移植物、切除移植物血管重建在内的治疗措施,这也反映了,目前处理人工血管动静脉内瘘成型术后感染仍然缺乏有效的手段。本研究目的在于评估包括血管重建在内的肱深动脉远端的肱动脉结扎术并移除人工血管(BAL)是否安全有效。
Methods
All prosthetic arteriovenous graft infections managed by a single surgeon between 1995 and 2006 were reviewed retrospectively. Patients were identified from a computerized vascular registry, and data were obtained via patient charts and the electronic medical record.
方法:对1995年至2006年间人工血管感染的病例进行回顾性分析。通过计算机血管图像匹配对所有患者进行身份识别,所有数据均通过病历及电子记录获得。

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作者:admin@医学,生命科学    2011-07-21 18:13
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