Guzel Yasin, Avşar Mustafa Kemal, Pişkin Ferhat Can, Abacı Enes Batuhan, Güzel Kadir Yasin, Yalınız Hafize, Topçuoğlu Mehmet Şah
Department of Cardiovascular Surgery, Çukurova University, Faculty of Medicine, Adana, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Dec 31;32(4 Suppl 2):101-102. doi: 10.5606/tgkdc.dergisi.2024.mep-05. eCollection 2024 Nov.
For chronic hemodialysis patients to have long-term vascular access, arteriovenous (AV) fistulas are essential. Immediate intervention is necessary for AV fistula thrombosis, a common complication in hemodialysis patients. To guarantee the fistula's long-term patency, surgical thrombectomy is crucial. Vascular access should be preserved in cases with issues, according to the literature. This case report aimed to provide a literature review and surgical management of brachial AV fistula thrombosis in hemodialysis patients. A 41-year-old female patient who was on hemodialysis for three years due to chronic renal failure presented to the clinic. On physical examination, no thrill was obtained from the left brachial AV fistula. The patient underwent emergency surgery. After systemic heparinization, the cephalic vein was explored from two places, and thrombectomy was performed. The cephalic vein was harvested from the forearm and a bypass was performed from the brachial artery to the cephalic vein. The patient was discharged without any postoperative complications. During the follow-up, the fistula remained functional, and hemodialysis continued without any problems. Surgical thrombectomy allows early treatment of thrombosis and preserves the continuity of vascular access required for hemodialysis. Regular follow-up of patients is critical for early diagnosis and treatment of AV fistula thrombosis, improving the patient's quality of life and ensuring uninterrupted continuation of dialysis treatment. This case demonstrates that vascular access can be achieved with surgical thrombectomy and bypass application in a patient with brachial AV fistula thrombosis, highlighting the importance of surgical approach in the management of AV fistula complications.
对于长期进行血液透析的患者而言，动静脉（AV）内瘘是实现长期血管通路的关键。AV内瘘血栓形成是血液透析患者常见的并发症，对此需要立即进行干预。为确保内瘘的长期通畅，手术取栓至关重要。根据文献记载，在出现问题的情况下应保留血管通路。本病例报告旨在对血液透析患者肱动脉AV内瘘血栓形成进行文献综述及手术治疗。一名41岁女性患者因慢性肾衰竭接受血液透析三年，前来就诊。体格检查时，左侧肱动脉AV内瘘未触及震颤。该患者接受了急诊手术。全身肝素化后，从两个部位探查头静脉并进行取栓。从前臂采集头静脉，然后进行从肱动脉到头静脉的搭桥手术。患者术后无任何并发症出院。随访期间，内瘘功能良好，血液透析持续顺利，未出现任何问题。手术取栓能够早期治疗血栓形成，并保留血液透析所需的血管通路的连续性。对患者进行定期随访对于早期诊断和治疗AV内瘘血栓形成、改善患者生活质量以及确保透析治疗不间断地持续进行至关重要。本病例表明，对于肱动脉AV内瘘血栓形成的患者，通过手术取栓和搭桥手术可以实现血管通路，凸显了手术方法在AV内瘘并发症管理中的重要性。
