Kahraman Nail, Demir Deniz
Bursa Yüksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery Bursa, Turkey.
Am J Transl Res. 2019 Feb 15;11(2):1058-1065. eCollection 2019.
Complications such as stenosis, thrombosis, aneurysmal dilatation, and infection occur in at least one-third of all arteriovenous fistulas (AVFs). Due to these complications, vascular access dysfunction develops in hemodialysis patients.
We investigated AVF rescue operations, which we performed for the pathologies causing dysfunctional vascular access, and outcomes of these operations by surgeon-performed preoperative ultrasound (US) in our clinic.
Retrospective Study.
Bursa Yüksek Ihtisas Training and Research Hospital Cardiovasculary Surgery Department, Turkey.
67 patients who were treated in our clinic due to AVF dysfunction between January 2012 and January 2016 were included in the study. Preoperative US evaluation for dysfunctional AVFs was performed by the surgeon conducting the operation. The patients were divided into 5 groups according to the pathologies such as stenosis, thrombosis, aneurysm, high-flow rate, and deep basilic vein.
Our goal in all patients with vascular access dysfunction was to maintain the AVF.
67 Patients.
In Group 1 (16 patients) which had stenosis and underwent AVF reconstruction, the 24-month primary patency rate was 81.3%. In Group 2 (9 patients) which had trombosis and underwent AVF reconstruction, the 24-month primary patency rate was 22.2%. In Group 3 (24 patients) which had AVF aneurysm and underwent AVF reconstruction, the 24-month primary patency rate was 70.8%. In Group 4 (10 patients) which had high flow and underwent AVF reconstruction, the 24-month primary patency rate was 90%. In Group 5 (8 patients) which had deep basilic vein and underwent AVF reconstruction, the 24-month primary patency rate was 75%.
Leaving patients with vascular access dysfunction to fate (no intervention) or AVF ligation is always simpler and easier. However, it should not be forgotten that paternity for vascular access are limited in these patients. We think that the primary target is to demonstrate AVF by physical examination and surgeon-performed detailed US and to make it again available for hemodialysis by reconstructing dysfunctional AVF using the most appropriate surgical strategy.
Retrospective, small sample size.
至少三分之一的动静脉内瘘（AVF）会出现诸如狭窄、血栓形成、动脉瘤样扩张和感染等并发症。由于这些并发症，血液透析患者会出现血管通路功能障碍。
我们研究了针对导致血管通路功能障碍的病变所进行的AVF挽救手术，以及在我们诊所由外科医生进行术前超声（US）检查后的手术结果。
回顾性研究。
土耳其布尔萨尤克谢赫伊斯塔斯培训与研究医院心血管外科。
纳入2012年1月至2016年1月间因AVF功能障碍在我们诊所接受治疗的67例患者。由实施手术的外科医生对功能障碍的AVF进行术前超声评估。根据狭窄、血栓形成、动脉瘤、高流量以及深部贵要静脉等病变将患者分为5组。
我们对所有血管通路功能障碍患者的目标是维持AVF。
67例患者。
第1组（16例患者）存在狭窄并接受了AVF重建，24个月的初次通畅率为81.3%。第2组（9例患者）存在血栓形成并接受了AVF重建，24个月的初次通畅率为22.2%。第3组（24例患者）存在AVF动脉瘤并接受了AVF重建，24个月的初次通畅率为70.8%。第4组（10例患者）存在高流量并接受了AVF重建，24个月的初次通畅率为90%。第5组（8例患者）存在深部贵要静脉并接受了AVF重建，24个月的初次通畅率为75%。
让血管通路功能障碍的患者听天由命（不干预）或结扎AVF总是更简单容易。然而，不应忘记这些患者的血管通路资源是有限的。我们认为首要目标是通过体格检查和外科医生进行的详细超声检查来评估AVF，并通过采用最合适的手术策略重建功能障碍的AVF，使其再次可用于血液透析。
回顾性研究，样本量小。
