| 特集名 | 高齢者の透析導入を再考する | |
|---|---|---|
| 題名 | 高齢者バスキュラーアクセスの作製上の問題点・留意点 | |
| 発刊年月 | 2016年 01月 | |
| 著者 | 大久保 健太郎 | 名古屋共立病院バスキュラーアクセス治療センター |
| 著者 | 佐藤 隆 | 名古屋共立病院バスキュラーアクセス治療センター |
| 著者 | 唐仁原 全 | 国際医療福祉大学熱海病院移植外科 |
| 【 要旨 】 | 高齢者にバスキュラーアクセス（VA）作製を行う場合に注意する点として，皮膚の菲薄化，心機能の低下，動静脈の荒廃，栄養状態や日常生活動作の悪化が挙げられる．穿刺のしやすさ，心臓や末梢循環への影響など合併症の少なさから，前腕橈側の自己血管内シャント（AVF）がもっとも理想的なVAである．橈骨動脈に高度な石灰化を伴っても軟化処置（硬化した血管壁を攝子で圧潰することで吻合を可能にする処置）を行うことで吻合が可能になる．それ以外の部位でのAVF作製や人工血管を用いたVA では欠点が増え，それらの欠点を最小限にする工夫が必要になる．とくに人工血管は，なるべく皮膚や心臓に負荷をかけず，穿刺や修復が行いやすいデザインが要求される．必要最低限の血流が安定して流れ続けるシャント作製を心がけ，高度な末梢動脈疾患や心不全を合併している場合は非シャント性のVAを考慮する． | |
| Theme | Reconsidering dialysis initiation for the elderly | |
|---|---|---|
| Title | Basic issues concerning vascular access construction and repair for maintenance hemodialysis in elderly patients | |
| Author | Kentaro Okubo | Vascular Access Treatment Center, Nagoya Kyoritsu Hospital |
| Author | Takashi Sato | Vascular Access Treatment Center, Nagoya Kyoritsu Hospital |
| Author | Tamotsu Tojimbara | Department of Transplant Surgery, International University of Health and Welfare, Atami Hospital |
| [ Summary ] | The increasing number of elderly patients receiving hemodialysis therapy has created some issues related to vascular access (VA) construction and maintenance. Elderly patients have various complications, including thin skin, heart failure, destruction and calcification of vessels, malnutrition, and low activity levels, leading to difficulties with VA surgery and higher failure rates during maintenance dialysis. Although arteriovenous fistula (AVF) in the forearm using the radial artery are the preferred form of VA associated with lower incidence of morbidity and mortality, there are various aspects regarding materials and configuration for artificial grafts in addition to the VA site. In some cases with severe arterial calcification, a softening procedure, namely, gentle crushing of the calcified part using tweezers, softens the vessel wall adequately to create an AVF. Graft insertion requires a design that allows easy puncture and repair, without putting a burden on the skin and heart. The grafts and fistulae induce cardiac loads, and patients may develop heart failure, especially elderly patients with impaired cardiac function. Superficialization of an artery or a cuffed central catheter (VA without fistula) is recommended in patients with low left ventricular ejection fractions of less than 30 %. It is necessary to understand the overall status of elderly patients and to devise appropriate VA construction methods. |
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