Lacombe M
Hôpital Beaujon, Clichy.
Ann Cardiol Angeiol (Paris). 1993 Apr;42(4):199-202.
Four patients suffering from severe digital ischemia due to emboli originating from a thrombosed arteriovenous fistula were operated on. In all cases, a large aneurysm had developed on the efferent vein. Segmental resection of the fistula and of the aneurysm with or without reanastomosis of the artery was successfully performed in all patients; a thoracic sympathectomy was performed in one because of the severity of the ischemic symptoms. Progressive degenerative changes of the arterialized vein account for the development of an aneurysm at its level with secondary thrombosis. When performing an arteriovenous fistula, end-to-end or end-to-side anastomosis of the artery prevents the occurrence of distal embolism in case of local thrombosis. Suppression of all aneurysmal fistulas is recommended whenever a kidney transplant ensures satisfactory function with sufficient follow-up.
对4例因血栓形成的动静脉瘘栓子导致严重手指缺血的患者进行了手术。所有病例中，流出静脉均形成了一个大的动脉瘤。所有患者均成功进行了瘘管和动脉瘤的节段性切除，动脉是否进行再吻合视情况而定；1例因缺血症状严重而进行了胸交感神经切除术。动脉化静脉的进行性退行性改变导致其水平处动脉瘤的形成及继发性血栓形成。进行动静脉瘘手术时，动脉的端端或端侧吻合可防止局部血栓形成时远端栓塞的发生。只要肾移植在充分随访的情况下能确保功能良好，建议切除所有动脉瘤性瘘管。
