Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
J Vasc Access. 2021 Nov;22(6):1026-1029. doi: 10.1177/1129729820968425. Epub 2020 Oct 26.
A mega fistula can be defined as generalized aneurysmal dilatation of arteriovenous fistula. Mega fistulae can lead to complications like high output cardiac failure, steal syndrome, skin ulceration and rupture. We describe a series of ten patients who were referred to our interventional nephrology practice for evaluation of mega fistula which had not been in use for a long time. Nine out of ten patients were post-transplant while one was pre dialysis. Five patients had Radiocephalic while four had Brachiocephalic and one had Brachial artery to Median Cubital vein fistula. All except one patient had severe outflow stenosis. The most common site of stenosis in Radiocepahlic and Brachiocepahlic fistula was cephalic vein at the elbow and cephalic arch respectively. Half of the patients had chronic total occlusion of the outflow vein. Successful angioplasty was done in only two patients. Seven patients underwent ligation while one had spontaneous thrombosis of the fistula. None of the patients had regular surveillance of their access for a long time as they were not on dialysis. Unrecognized and uncorrected outflow stenosis over a long time period can lead to creation of mega fistula. Once a mega fistula develops there are not many treatment options other than ligation. This leads to loss of the access which might be needed in future. Continuous access surveillance in patients who are not on dialysis is important to prevent complications like mega fistula.
巨型瘘管可定义为动静脉瘘的广泛动脉瘤样扩张。巨型瘘管可导致心力衰竭、窃血综合征、皮肤溃疡和破裂等并发症。我们描述了一组 10 例因长期未使用的巨型瘘管而转诊至我们的介入肾脏病学实践的患者。10 例患者中有 9 例为移植后患者，1 例为透析前患者。5 例为头臂瘘，4 例为肱动脉-头静脉瘘，1 例为肱动脉-正中静脉瘘。除 1 例患者外，所有患者均存在严重的流出道狭窄。头臂瘘和肱动脉-头静脉瘘狭窄最常见的部位分别是肘头静脉和头静脉弓。一半的患者流出静脉存在慢性完全闭塞。仅 2 例患者成功进行了血管成形术。7 例患者行结扎术，1 例患者瘘管自发性血栓形成。由于这些患者长期未进行透析，因此未对其通路进行长期规律监测。长时间未识别和未纠正的流出道狭窄可导致巨型瘘管的形成。一旦形成巨型瘘管，除结扎外，治疗选择并不多。这会导致通路的丧失，而在未来可能需要该通路。对于未进行透析的患者，持续监测通路对于预防巨型瘘管等并发症非常重要。
