Góra Rafał, Bojakowski Krzysztof, Foroncewicz Bartosz, Kaźmierczak Stanisław, Andziak Piotr
2nd Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Vascular. 2020 Dec;28(6):775-783. doi: 10.1177/1708538120931626. Epub 2020 Jun 11.
Dialysis fistula aneurysms are common complications which in selective cases require surgical revision. It is recommended to detect and treat outflow stenosis concurrent with a dialysis fistula aneurysm, but usually, the treatment is divided into two stages - the open and endovascular stages are performed separately. We describe the results of hybrid procedures composed of aneurysm resection and endovascular correction for outflow veins performed for a dialysis fistula aneurysm treatment.
From March 2012, we performed hybrid procedures in 28 patients to correct dialysis fistula aneurysms. Patients, dialysis access, operative data, and the results obtained during a median follow-up of 28.5 months were analyzed.
For dialysis fistula aneurysm correction, we performed 27 bypasses and 1 aneurysmorraphy. For outflow vein stenosis correction, we performed standard balloon angioplasty, no stents or stentgraft were used. The average increase in minimal diameter after angioplasty was 135.5% (range 57-275%). The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 92.3% and 80%, respectively. A significant difference in the one-year patency rates between the urgent and planned procedures was observed (81.2% vs. 100%, respectively). No early complications related to endovascular or open procedures were observed. Late complications were observed in seven patients (25%) - mainly thrombosis caused by the recurrence of outflow vein stenosis (six patients, 21.5%), infection, lymphocele, and hematoma (one case of each complication).
A hybrid procedure for the surgical correction of dialysis fistula aneurysms with the simultaneous correction of outflow pathologies enables effective long-term treatment. The obtained data showed the efficiency and good results of this procedure. Procedures performed for urgent indications significantly increase the risk for later complications, especially fistula thrombosis and loss of dialysis access.
透析动静脉内瘘动脉瘤是常见并发症，部分病例需要手术修复。建议在处理透析动静脉内瘘动脉瘤时同时检测并治疗流出道狭窄，但通常治疗分为两个阶段——开放手术阶段和血管腔内治疗阶段分别进行。我们描述了用于治疗透析动静脉内瘘动脉瘤的动脉瘤切除联合血管腔内流出静脉矫正的杂交手术结果。
自2012年3月起，我们对28例患者实施了杂交手术以矫正透析动静脉内瘘动脉瘤。分析了患者、透析通路、手术数据以及在中位随访28.5个月期间获得的结果。
为矫正透析动静脉内瘘动脉瘤，我们实施了27例搭桥手术和1例动脉瘤缝补术。为矫正流出道狭窄，我们实施了标准球囊血管成形术，未使用支架或覆膜支架。血管成形术后最小直径的平均增加幅度为135.5%（范围为57%至275%）。观察组中矫正后的内瘘12个月和24个月的原发性通畅率分别为92.3%和80%。观察到急诊手术和择期手术的一年通畅率存在显著差异（分别为81.2%和100%）。未观察到与血管腔内手术或开放手术相关的早期并发症。7例患者（25%）出现晚期并发症——主要是由流出道狭窄复发导致的血栓形成（6例患者，21.5%）、感染、淋巴囊肿和血肿（各1例并发症）。
一种用于手术矫正透析动静脉内瘘动脉瘤并同时矫正流出道病变的杂交手术能够实现有效的长期治疗。所获得的数据显示了该手术的有效性和良好效果。因急诊指征实施的手术显著增加了后期并发症的风险，尤其是内瘘血栓形成和透析通路丧失。
