Chandrashekar A R, Hoskatti Chetan R, Desai Sanjay C, Prasad Rajendra B
Department of Vascular and Endovascular Surgery, Ramaiah Medical College, Bengaluru, India.
Department of Vascular and Endovascular Surgery, Ramaiah Medical College, Bengaluru, India.
Ann Vasc Surg. 2018 Apr;48:75-78. doi: 10.1016/j.avsg.2017.10.013. Epub 2017 Dec 5.
Arteriovenous graft (AVG) infections can present as major life-threatening hemorrhage or sepsis in a chronic kidney disease patient. Frequently, all these patients present in critical condition which need prompt and expeditious management. Various procedures are described for management of infected grafts and its bleeding complications. However, these procedures are associated with postop-operative bleeding and persistent infection. The aim was to study brachial artery ligation (BAL) near the elbow joint in the management of an infected AVG.
It was a retrospective study where data collection was done for 51 patients who underwent BAL in infected AVGs from January 2007 to December 2016.
During the study period, AVG infections were treated in 62 patients. Fifty-one BALs were done in 62 limbs treated. All were arm grafts (brachial artery to axillary vein) using expanded polytetrafluoroethylene grafts. In 49 patients, BAL was done as a primary procedure. In 2 patients, BAL was done after they presented with uncontrolled infection after initial subtotal excision with oversewing of graft stump at arterial anastomosis. There were 36 men and 15 women, with a mean age of 49 years (range, 23-82). The primary etiologies for renal failure were hypertension (56.2%), diabetes (34.3%), and others (9.5%). Follow-up was 100% at 1 month and 82.3% (42 patients) at 3 months, and none showed any signs of ischemia or sepsis. All had biphasic signals in radial and ulnar arteries with normal peripheral capillary oxygen saturation readings in fingers. None of the patients underwent additional interventions.
BAL in AVG infections is a safe alternative considering the critical general condition of chronic kidney disease patient. It reduces the operative time significantly and avoids complex revascularization and anastomotic dehiscence without any ischemic or bleeding complications. BAL near the elbow joint in patients with good back-bleeding can be used as a primary approach in an infected AVG. However, close monitoring of patient in postoperative period is essential.
动静脉移植物（AVG）感染在慢性肾病患者中可表现为危及生命的大出血或败血症。通常，所有这些患者病情危急，需要迅速且及时的处理。针对感染移植物及其出血并发症的处理，有多种方法被描述。然而，这些方法都伴有术后出血和持续感染的问题。本研究旨在探讨肘关节附近肱动脉结扎术（BAL）在处理感染性AVG中的应用。
这是一项回顾性研究，收集了2007年1月至2016年12月期间51例行感染性AVG肱动脉结扎术患者的数据。
在研究期间，共治疗了62例AVG感染患者。在接受治疗的62条肢体中进行了51次肱动脉结扎术。所有均为使用膨体聚四氟乙烯移植物的上臂移植物（肱动脉至腋静脉）。49例患者中，肱动脉结扎术作为主要手术进行。2例患者在初次部分切除并缝合动脉吻合口处的移植物残端后出现无法控制的感染，随后进行了肱动脉结扎术。患者中男性36例，女性15例，平均年龄49岁（范围23 - 82岁）。肾衰竭的主要病因是高血压（56.2%）、糖尿病（34.3%）和其他（9.5%）。1个月时随访率为100%，3个月时为82.3%（42例患者），且均未出现缺血或败血症的迹象。桡动脉和尺动脉均有双相信号，手指外周毛细血管氧饱和度读数正常。所有患者均未接受额外干预。
考虑到慢性肾病患者的危急总体状况，AVG感染时的肱动脉结扎术是一种安全的选择。它显著缩短了手术时间，避免了复杂的血管重建和吻合口裂开，且无任何缺血或出血并发症。对于回血良好的患者，肘关节附近的肱动脉结扎术可作为感染性AVG的主要治疗方法。然而，术后密切监测患者至关重要。
