{"id":5856,"date":"2023-08-28T16:37:57","date_gmt":"2023-08-28T21:37:57","guid":{"rendered":"https:\/\/staging.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=5856"},"modified":"2025-05-09T10:58:43","modified_gmt":"2025-05-09T15:58:43","slug":"acceso-vascular-una-breve-resena-sp","status":"publish","type":"article","link":"https:\/\/staging.advancedrenaleducation.com\/wparep\/article\/acceso-vascular-una-breve-resena-sp\/","title":{"rendered":"Acceso Vascular: Una Breve Rese\u00f1a"},"content":{"rendered":"<p>M\u00e1s del 90% de los pacientes en di\u00e1lisis en los Estados Unidos dependen de la hemodi\u00e1lisis cr\u00f3nica (HD) para la terapia de reemplazo renal<sup>1,2<\/sup>. Un tratamiento de hemodi\u00e1lisis est\u00e1ndar incluye el procesamiento continuo de aproximadamente 200-600 ml de sangre por minuto durante un per\u00edodo de 3-4 horas y se realiza 3 veces por semana3. Este tratamiento requiere un acceso seguro y f\u00e1cilmente disponible al sistema circulatorio.<\/p>\n<p>El objetivo principal del acceso vascular de la HD cr\u00f3nica es proporcionar un acceso repetido a la circulaci\u00f3n con complicaciones m\u00ednimas<sup>1,4,5<\/sup>. Un acceso vascular que funcione bien es esencial para la supervivencia del paciente y debe tener las siguientes caracter\u00edsticas<sup>6<\/sup>:<\/p>\n<ul>\n<li>Seguridad\n<ul>\n<li>Pocas complicaciones<\/li>\n<\/ul>\n<\/li>\n<li>De confianza\n<ul>\n<li>Proporcionar acceso repetido a la circulaci\u00f3n.<\/li>\n<li>Proporcionar un flujo sangu\u00edneo continuo de 400-600 ml \/ min.<\/li>\n<li>Duradero<\/li>\n<\/ul>\n<\/li>\n<li>Sencillo\n<ul>\n<li>F\u00e1cil de colocar<\/li>\n<li>F\u00e1cil de usar<\/li>\n<\/ul>\n<\/li>\n<li>Aceptable para el paciente\n<ul>\n<li>Indoloro<\/li>\n<li>Cosm\u00e9ticamente aceptable<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Una f\u00edstula arteriovenosa (FAV) que funciona bien es la que m\u00e1s se acerca a cumplir las caracter\u00edsticas anteriores. Se crea mediante la anastomosis (conexi\u00f3n quir\u00fargica) de una vena y una arteria, generalmente la arteria radial y la vena cef\u00e1lica en el antebrazo. La FAV es la forma m\u00e1s confiable de acceso vascular permanente y tiene el menor n\u00famero de complicaciones<sup>1,4,5<\/sup>. Por este motivo, se considera que el AVF es el acceso de elecci\u00f3n.<\/p>\n<p>Adem\u00e1s de la FAV, se utilizan otras tres formas de acceso vascular de la HD cr\u00f3nica:<\/p>\n<ul>\n<li>Injerto de puente prot\u00e9sico o injerto AV (IAV): conexi\u00f3n quir\u00fargica de una arteria a una vena mediante un tubo sint\u00e9tico. Se colocan con mayor frecuencia en brazos o muslos y son otra opci\u00f3n para el acceso permanente a hemodi\u00e1lisis <sup>1,6<\/sup><\/li>\n<li>Cat\u00e9ter venoso central (CVC): se coloca un cat\u00e9ter a trav\u00e9s de la piel hasta la vena yugular, femoral o subclavia. Los CVC se utilizan t\u00edpicamente para el acceso temporal y no se prefieren para el acceso a largo plazo debido a las altas tasas de infecci\u00f3n y trombo <sup>1,6<\/sup>.<\/li>\n<li>Derivaciones AV: una c\u00e1nula externa colocada quir\u00fargicamente compuesta por un tubo de sil\u00e1stico en forma de U con puntas de tefl\u00f3n (p. Ej., Quinton-Scribner o Thomas Shunt) que conecta una arteria y una vena. Aunque rara vez se utilizan hoy en d\u00eda, fueron el acceso vascular \u201cpermanente\u201d original para la HD<sup>1,7<\/sup>.<\/li>\n<\/ul>\n<p>La creaci\u00f3n y el mantenimiento de una FAV funcional seguir\u00e1 siendo uno de los mayores desaf\u00edos en el campo de la di\u00e1lisis<sup>7\u20139<\/sup>. A pesar de que m\u00faltiples estudios han demostrado la superioridad general de los resultados cl\u00ednicos de la FAV, incluidas tasas m\u00e1s bajas de trombosis, infecci\u00f3n, septicemia<sup>1,4,5,10<\/sup>, existe una amplia variaci\u00f3n global en la utilizaci\u00f3n del acceso vascular. Esta variaci\u00f3n se ha atribuido en diversos grados a las caracter\u00edsticas del paciente, los patrones de pr\u00e1ctica quir\u00fargica, los sistemas de administraci\u00f3n, las tecnolog\u00edas disponibles y el sesgo del m\u00e9dico y el paciente<sup>8,11<\/sup>. La comunidad renal internacional est\u00e1 trabajando junta para enfrentar estos desaf\u00edos con esfuerzos dedicados y sostenidos para mejorar la tecnolog\u00eda de acceso vascular, la pr\u00e1ctica cl\u00ednica y la pol\u00edtica de atenci\u00f3n m\u00e9dica.<\/p>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid\" style=\"width:100%;margin-top:20px;margin-bottom:20px;border-top-width:1px;border-color:#dddddd;\"><\/div>\n<h4><strong>Referencias<\/strong>:<\/h4>\n<ol>\n<li>Maya ID, Allon M. Vascular Access: Core Curriculum 2008. <em>Am J Kidney Dis<\/em>. 2008;51(4):702-708. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18371547.<\/li>\n<li>United States Renal Data System. 2019 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2019. Available from: https:\/\/www.usrds.org\/annual-data-report\/.<\/li>\n<li>Singh A, Kari J. Management of CKD Stages 4 and 5: Preparation for Transplantation, Dialysis, or Conservative Care. In: Daugirdas JT, Blake P, Ing TS, eds. <em>Handbook of Dialysis<\/em>. 5th ed. Walters Kluwer Health; 2015:22-31.<\/li>\n<li>McCann M, Einarsd\u00f3ttir H, Van Waeleghem J-P, Murphy F, Sedgewick J. Vascular access management 1: an overview. <em>J Ren Care<\/em>. 2008;34(2):77-84. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18498572.<\/li>\n<li>Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. <em>Am J Kidney Dis<\/em>. 2020;75(4):S1-S164. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/32778223\/.<\/li>\n<li>Sands J. Vascular access 2007. <em>Minerva Urol e Nefrol<\/em>. 2007;59((3)):237-249.<\/li>\n<li>Ethier J, Mendelssohn DC, Elder SJ, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. <em>Nephrol Dial Transplant<\/em>. 2008;23(10):3219-3226. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/18511606\/.<\/li>\n<li>Wish JB. Vascular access for dialysis in the United States: progress, hurdles, controversies, and the future. <em>Semin Dial<\/em>. 2010;23(6):614-618. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21175835.<\/li>\n<li>Kulawik D, Sands JJ, Mayo K, et al. Focused vascular access education to reduce the use of chronic tunneled hemodialysis catheters: results of a network quality improvement initiative. <em>Semin Dial<\/em>. 2009;22(6):692-697. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20017841.<\/li>\n<li>Astor BC, Eustace JA, Powe NR, et al. Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. <em>Am J Kidney Dis<\/em>. 2001;38(3):494-501. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11532680.<\/li>\n<li>Vachharajani TJ. Hemodialysis Vascular Access Care in the United States: Closing Gaps in the Education of Patient Care Technicians. <em>Semin Dial<\/em>. 2011;24(1):92-96. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21338399.<\/li>\n<\/ol>\n<p>P\/N 101031-01S Rev A 02\/2023<\/p>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[274],"tags":[208],"language":[42],"articles":[272],"class_list":["post-5856","article","type-article","status-publish","format-standard","hentry","category-articulos","tag-access-sp","language-spanish","articles-hemodialisis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Acceso Vascular: Una Breve Rese\u00f1a - Advanced Renal Education Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/staging.advancedrenaleducation.com\/wparep\/article\/acceso-vascular-una-breve-resena-sp\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Acceso Vascular: Una Breve Rese\u00f1a - Advanced Renal Education Program\" \/>\n<meta property=\"og:description\" content=\"M\u00e1s del 90% de los pacientes en di\u00e1lisis en los Estados Unidos dependen de la hemodi\u00e1lisis cr\u00f3nica (HD) para la terapia de reemplazo renal1,2. 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