Abstract：
UNASSIGNED: It is likely that there will be an increasing role for early-cannulation arteriovenous grafts (ecAVG) with a wider recognition of the need to tailor vascular access to avoid futile procedures and unnecessary TCVC. However, experience of these products is not common and limited to early surgical adopters, with little information on the systemic changes and multi-disciplinary care needed to optimize outcomes. The aim of this study was to report the impact of a multi-disciplinary approach on quantifiable outcomes.
UNASSIGNED: A retrospective analysis of a prospectively maintained database of 295 ecAVG implanted over an 8-year time-period was performed. Indicative outcomes were chosen to reflect nephrology (patient selection), nursing care (cannulation complications of infection and pseudoaneurysm) and radiology (thrombosis) on cumulative impact (functional patency) over three distinct time periods.
UNASSIGNED: The incidence of ecAVG increased 10-fold over the three time periods. The use of ecAVG changed significantly from salvage tertiary access to TCVC avoidance and salvage of existing AVF. Nursing complications reduced markedly with significantly fewer over-cannulation episodes and pseudo-aneurysms. With an improved pro-active surveillance programme, the time to first thrombosis doubled and the risk of thrombosis halved. Ultimately this resulted in significantly improved functional patency with a risk of ecAVG loss less than one-third by the last time-period.
UNASSIGNED: All aspects of ecAVG use require scrutiny and critical appraisal. Failure or success is not simply achieved by performing good technical surgery with an efficacious product, but by the care taken across a wide range of elements spanning case selection, implantation, use and maintenance.
UNASSIGNED: A retrospective analysis of a prospectively maintained database of 295 ecAVG implanted over an 8-year time-period was performed. Indicative outcomes were chosen to reflect nephrology (patient selection), nursing care (cannulation complications of infection and pseudoaneurysm) and radiology (thrombosis) on cumulative impact (functional patency) over three distinct time periods.
UNASSIGNED: The incidence of ecAVG increased 10-fold over the three time periods. The use of ecAVG changed significantly from salvage tertiary access to TCVC avoidance and salvage of existing AVF. Nursing complications reduced markedly with significantly fewer over-cannulation episodes and pseudo-aneurysms. With an improved pro-active surveillance programme, the time to first thrombosis doubled and the risk of thrombosis halved. Ultimately this resulted in significantly improved functional patency with a risk of ecAVG loss less than one-third by the last time-period.
UNASSIGNED: All aspects of ecAVG use require scrutiny and critical appraisal. Failure or success is not simply achieved by performing good technical surgery with an efficacious product, but by the care taken across a wide range of elements spanning case selection, implantation, use and maintenance.
摘要：
■早期插管动静脉移植物（ecAVG）的作用可能会越来越大，因为人们更广泛地认识到需要定制血管通路以避免徒劳的手术和不必要的TCVC。然而,这些产品的经验并不常见，仅限于早期手术采用者，关于优化结果所需的系统性变化和多学科护理的信息很少。这项研究的目的是报告多学科方法对可量化结果的影响。
■在8年的时间内对295个ecAVG植入的前瞻性维护数据库进行回顾性分析。选择指示性结果以反映肾脏病学（患者选择），护理（感染和假性动脉瘤的插管并发症）和放射学（血栓形成）对三个不同时间段的累积影响（功能通畅）。
■在三个时间段内，ecAVG的发生率增加了10倍。从救助三级访问到TCVC避免和救助现有AVF，ecAVG的使用发生了显着变化。护理并发症显着减少，过度插管发作和假性动脉瘤明显减少。有了改进的主动监测方案，第一次血栓形成的时间增加了一倍，血栓形成的风险减少了一半。最终，这导致功能通畅性的显着改善，在最后一个时间段内，ecAVG损失的风险小于三分之一。
■使用ecAVG的所有方面都需要审查和严格的评估。失败或成功不是简单地通过使用有效的产品进行良好的技术手术来实现的，但是通过对案例选择的广泛因素的关注，植入,使用和维护。
■在8年的时间内对295个ecAVG植入的前瞻性维护数据库进行回顾性分析。选择指示性结果以反映肾脏病学（患者选择），护理（感染和假性动脉瘤的插管并发症）和放射学（血栓形成）对三个不同时间段的累积影响（功能通畅）。
■在三个时间段内，ecAVG的发生率增加了10倍。从救助三级访问到TCVC避免和救助现有AVF，ecAVG的使用发生了显着变化。护理并发症显着减少，过度插管发作和假性动脉瘤明显减少。有了改进的主动监测方案，第一次血栓形成的时间增加了一倍，血栓形成的风险减少了一半。最终，这导致功能通畅性的显着改善，在最后一个时间段内，ecAVG损失的风险小于三分之一。
■使用ecAVG的所有方面都需要审查和严格的评估。失败或成功不是简单地通过使用有效的产品进行良好的技术手术来实现的，但是通过对案例选择的广泛因素的关注，植入,使用和维护。
