[Long-term results of chest wall arteriovenous graft for establishing hemodialysis access].

目的: 探讨胸壁人工血管透析通路（chest wall arteriovenous graft，CWAVG）作为终末期肾病血液透析通路的远期疗效。. 方法: 回顾分析 2014 年 1 月—2015 年 6 月，因上肢血管通路耗竭而建立 CWAVG 的 12 例终末期肾病患者临床资料。其中男 3 例，女 9 例；年龄 54～82 岁，平均 63.6 岁。慢性肾病病因：慢性肾小球肾炎 2 例，高血压肾损害 4 例，糖尿病肾病 1 例，泌尿系肿瘤、双肾切除术后 3 例，不详 2 例。血液透析时间 1～144 个月，平均 38.4 个月。行 CWAVG 前通路失功次数 1～14 次，平均 4.2 次，均因透析通路反复闭塞或上肢血管条件极差造成上肢血管通路耗竭。. Results: All patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis. Conclusion: Although the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.