Al-Thani Hassan, El-Menyar Ayman, Al-Thani Noora, Asim Mohammad, Hussein Ahmed, Sadek Ahmed, Sharaf Ahmed, Fares Amr
Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar.
Department of Internal Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.
Ann Vasc Surg. 2017 May;41:46-55. doi: 10.1016/j.avsg.2016.08.046. Epub 2017 Feb 24.
To investigate the clinical characteristics, surgical interventions, and outcomes of arteriovenous fistula (AVF) aneurysms, we retrospectively analyzed patients on regular hemodialysis (HD).
We conducted a cohort study of all patients with HD access who presented with AVF aneurysms and underwent operative procedures over a 11-year period. Patients' demographics, comorbidities, vascular access characteristics, management of aneurysms, complications, and outcomes were analyzed.
Of the 700 end-stage renal failure patients, 530 patients were maintained on HD (130 through PermCath and 400 through AV access in terms of AVF and arteriovenous graft). We identified 129 patients who developed AV aneurysms, and 40 of them required surgical interventions (24 men and 16 women) with a mean age of 58 ± 14.6 years. The 40 patients who developed AVF aneurysms underwent 43 surgical interventions. The majority of aneurysms were presented with thinning and ulceration (82.5%) of the overlying skin. Thirty-four patients had true aneurysms and 6 had pseudoaneurysms. The aneurysmal AVF comprised 26 brachiocephalic fistulas, 9 radiocephalic fistulas, 3 brachial artery grafts, 1 ulnar-basilic fistula, and 1 Fem-Fem graft at presentation. Patients were treated mainly with ligation (13; 32.5%), excision and repair with graft interposition (15; 37.5%) or vein interposition (11; 27.5%), and end-to-end AVF (1; 2.5%). The median follow-up postsurgery duration was 53 months (range 1-192) and the median duration from fistula creation to the surgical intervention was 52 months (range 4-182). On follow-up, 34 patients continued on HD, while 5 underwent renal transplantation and 1 shifted to peritoneal dialysis. The overall all-cause mortality rate was 37.5% and the leading causes of mortality were sepsis/pneumonia (60%), myocardial infarction, and heart failure (40%).
In HD patients, the rate of AVF aneurysmal formation is high with a significant rate of morbidity and mortality. Therefore, timely and appropriate evaluation and surgical intervention are crucial.
为了研究动静脉内瘘（AVF）动脉瘤的临床特征、手术干预措施及预后，我们对接受规律血液透析（HD）的患者进行了回顾性分析。
我们对在11年期间内所有因AVF动脉瘤而接受手术治疗的HD患者进行了一项队列研究。分析了患者的人口统计学资料、合并症、血管通路特征、动脉瘤的处理方式、并发症及预后情况。
在700例终末期肾衰竭患者中，530例接受HD治疗（其中130例通过长期中心静脉导管，400例通过AVF和动静脉移植物建立AV通路）。我们识别出129例发生AV动脉瘤的患者，其中40例需要手术干预（24例男性和16例女性），平均年龄为58±14.6岁。发生AVF动脉瘤的40例患者接受了43次手术干预。大多数动脉瘤表现为覆盖皮肤变薄和溃疡（82.5%）。34例为真性动脉瘤，6例为假性动脉瘤。动脉瘤性AVF在初诊时包括26例头臂内瘘、9例桡动脉-头静脉内瘘、3例肱动脉移植物、1例尺动脉-贵要静脉内瘘和1例股-股移植物。患者主要接受结扎治疗（13例；32.5%）、切除并用人造血管间置修复（15例；37.5%）或静脉间置修复（11例；27.5%）以及端到端AVF修复（1例；2.5%）。术后中位随访时间为53个月（范围1 - 192个月），从内瘘建立到手术干预的中位时间为52个月（范围4 - 182个月）。随访时，34例患者继续接受HD治疗，5例接受肾移植，1例转为腹膜透析。总体全因死亡率为37.5%，主要死亡原因是脓毒症/肺炎（60%）、心肌梗死和心力衰竭（40%）。
在HD患者中，AVF动脉瘤形成率较高，且发病率和死亡率显著。因此，及时、恰当的评估和手术干预至关重要。
