目的评价高位动静脉内瘘在前臂常规内瘘不良的血液透析患者中的应用效果和优点。方法对40 例前臂无法行常规动静脉内瘘的血液透析患者建立高位动静脉内瘘，观察内瘘的使用情况及并发症。结果39 例患者手术一次性成功，1 例因静脉条件太差未获成功，予长期深静脉置管，内瘘在术后4～8 周成熟后开始穿刺，血流量均可达230～300ml/min。并发症：4 例在使用过程中血栓形成导致内瘘堵塞；5 例出现内瘘侧远端肢体肿胀，不影响患者身体功能和透析治疗。结论高位动静脉内瘘在血管条件差的透析患者中应用效果良好，还可以保护患者血管资源，为移植血管作准备。

Objective To evaluate the effect and advantage of arteriovenous internal fistula at higher site in hemodialysis patients with dysfunction of standard arteriovenous fistula in forearm. Methods Arteriovenous internal fistula at higher site was made in 40 uremia patients whose vascular condition in forearm was inadequate for successful construction of an internal arteriovenous fistula. We then analyzed the advantages and complications of the internal fistulas at higher site. Results The operation was successfully performed in 39 cases and was failed in one case because of the bad vascularity condition; long-term deep vein catheterization
was then used in this case. The internal fistulas were used for hemodialysis after 4～8 weeks, and the blood flow can reach 230～300 ml/min. Blockage of the internal fistulas due to thrombosis was found in 4 cases. Swelling of distal limbs was detected in 5 cases, not affecting physical activity and blood access in hemodialysis. Conclusions Arteriovenous internal fistula at higher site can be successfully used in patients with poor vascularity condition in forearm. This operation can also protect patient's blood vessels for the preparation of vascular graft.