Bilkent City Hospital, Yuksek Ihtisas Kalp Damar Cerrahisi Hastanesi, Ankara, Turkey.
SBU Derince Egitim Arastirma Hastanesi, Kocaeli, Turkey.
Ther Apher Dial. 2021 Dec;25(6):947-953. doi: 10.1111/1744-9987.13630. Epub 2021 Mar 16.
Autologous arteriovenous fistulas are commonly constructed in patients undergoing hemodialysis for end-stage renal disease. However, they are associated with a high rate of aneurysm formation, and aneurysmal arteriovenous fistulas that have become symptomatic require surgical intervention. This study was performed to evaluate the midterm results of salvage surgery for autogenous dialysis access in patients with aneurysmal arteriovenous fistulas. Of 1326 arteriovenous fistula operations, 81 involving surgery for aneurysmal arteriovenous fistulas between January 2008 and January 2012 were included in this study. The database was searched to identify all complicated arteriovenous fistula patients undergoing surgery for vascular access. The number of complicated arteriovenous fistula surgeries, for example for aneurysms, was greater than the number of patients undergoing surgery to create a new arteriovenous fistula. We performed three different surgical procedures to treat arteriovenous-related aneurysms in our clinic: primary repair, resection and saphenous vein interposition, and resection and polytetrafluoroethylene (PTFE) interposition. We compared the patency rates at the 12- and 24-month follow-ups among these three techniques. The study population consisted of 24 cases of primary repair, 29 cases of resection and saphenous vein interposition, and 30 cases of resection and PTFE graft interposition. True aneurysms occurring in patients undergoing hemodialysis did not require treatment unless they were symptomatic. Arteriovenous access salvage therapy is recommended after the aneurysm has become symptomatic. Symptomatic arteriovenous fistula aneurysms can be treated by maintaining arteriovenous fistula continuity. Moreover, patient safety is ensured by long-term patency.
自体动静脉瘘通常在接受终末期肾病血液透析的患者中构建。然而，它们与高动脉瘤形成率相关，并且出现症状的动脉瘤性动静脉瘘需要手术干预。本研究旨在评估挽救性手术治疗自体透析通路中动脉瘤性动静脉瘘的中期结果。在 2008 年 1 月至 2012 年 1 月期间，对 1326 例动静脉瘘手术中，纳入了 81 例因动脉瘤性动静脉瘘而行手术的患者。通过数据库检索确定所有因血管通路复杂而行手术的动静脉瘘患者。例如，因动脉瘤而行复杂动静脉瘘手术的数量多于创建新动静脉瘘的手术数量。我们在诊所采用了三种不同的手术方法来治疗与动静脉相关的动脉瘤：直接修复、切除和大隐静脉移植、切除和聚四氟乙烯（PTFE）移植。我们比较了这三种技术在 12 个月和 24 个月随访时的通畅率。研究人群包括 24 例直接修复、29 例切除和大隐静脉移植、30 例切除和 PTFE 移植。在接受血液透析的患者中，发生的真性动脉瘤不需要治疗，除非它们出现症状。建议在动脉瘤出现症状后进行动静脉通路挽救治疗。有症状的动静脉瘘动脉瘤可以通过保持动静脉瘘连续性来治疗。此外，长期通畅可确保患者安全。
