Kaller Réka, Mureșan Adrian Vasile, Arbănași Emil Marian, Arbănași Eliza Mihaela, Kovács István, Horváth Emőke, Suciu Bogdan Andrei, Hosu Ioan, Russu Eliza
Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania.
Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania.
Life (Basel). 2022 Apr 3;12(4):529. doi: 10.3390/life12040529.
Autologous native arteriovenous fistula (AVF) created in the non-dominant arm is the gold standard vascular access for dialysis in end-stage renal disease, but the post-surgical vascular access dysfunction causes a reduction in the patient's quality of life. Creating a functional upper extremity permanent arteriovenous access is limited by the upper limb's vascular resources, so good management of a complicated arteriovenous fistula may improve patient outcomes. This article highlights the importance of new surgical options in treating complicated AVFs.
We present the case of a patient with a 17-year-old complex radio-cephalic arterio-venous fistula and a series of surgical interventions performed for life salvage in the first place and functional vascular access in the second place. Furthermore, we describe a successfully created uncommon type of fistula in the lower extremity between the great saphenous vein and the anterior tibial artery as the last possible access for hemodialysis in this patient.
The patient underwent the first successful dialysis using the newly created lower limb fistula 1 month after the surgery.
Applying new surgical techniques to manage AVFs gives a unique chance to improve the quality of life and reduce morbidity and mortality in these patients.
在非优势手臂建立自体天然动静脉内瘘（AVF）是终末期肾病患者透析的金标准血管通路，但术后血管通路功能障碍会导致患者生活质量下降。由于上肢血管资源限制，建立功能性上肢永久性动静脉通路存在一定局限性，因此，对复杂动静脉内瘘进行良好管理可能改善患者预后。本文强调了新手术方案在治疗复杂AVF中的重要性。
我们报告一例患有17年复杂桡动脉-头静脉内瘘的患者，首先进行了一系列旨在挽救生命、其次是建立功能性血管通路的手术干预。此外，我们描述了在该患者下肢成功建立了一种罕见的大隐静脉与胫前动脉之间的内瘘，作为其最后可行的血液透析通路。
术后1个月，患者首次使用新建立的下肢内瘘成功进行了透析。
应用新的手术技术管理AVF为改善这些患者的生活质量、降低发病率和死亡率提供了独特机会。
