Surgical interventions for autogenous arteriovenous fistula aneurysms in hemodialysis patients

Yıl 2018, Cilt: 4 Sayı: 3, 180 - 186, 04.07.2018

Kadir Kaan Özsin , Umut Serhat Sanrı , Nail Kahraman , Faruk Toktaş , Şenol Yavuz

https://doi.org/10.18621/eurj.422085

Öz

Objectives. The aim of this study was to emphasize the importance
of surgical intervention perfotmed before development of arteriovenous fistula (AVF)
aneurysm complications. Methods. The patients were categorized
 into two groups: Patients undergoing elective
surgery for autogenous AVF aneurysm were defined as elective group (Group 1), whereas
those who underwent emergency surgery due to ruptured aneurysmal fistulas were
defined as emergency group (Group 2). All elective cases were evaluated by
doppler ultrasonography before surgery. All patients had temporary hemodialysis
catheters. In the patients with salvaged fistulas, the fistulas was rested for
1 week. A new fistula was created in patients with not salvaged fistula. Results. A total of 31 patients (54.8% male, mean age: 41.2 ± 14.7 years) were in
Group 1 and 7 patients (57.1% male, mean age: 53 ± 9.4 years) were in Group 2. Significant
difference was observed between two groups in terms of fistula preservation.
Salvaged fistulas were significantly higher in the Group 1 than Group 2 (p = 0.003). In Kaplan-Meier curves,
cumulative primary AVF patency rates at 1, 3 and 6 months were 96.3%, 81.5%,
and 77.8% in Group 1 and 66.7%, 66.7%, and 66.7% in Group 2, respectively (log-rank;
p = 0.536). Conclusions. Consultation
of these cases with a cardiovascular surgeon before they reach the rupture
stage is an important condition for both the patency of the fistula and the
vital risk of the patient. 

Anahtar Kelimeler

Arteriovenous fistula aneurysms, salvage treatment, hemodialysis

Kaynakça

• [1] Rahman A, Özsin KK. [Upper extremity autogenous arteriovenous fistulas for hemodialysis]. Turkish J Vasc Surg 2007;16:19-24. [Article in Turkish]
• [2] Bachleda P, Utikal P, Zadrazil J, Grosmanova T. Aneurysm as a complication of arteriovenous anastomoses for hemodialysis. Rozhl Chir 1998;77:541-4.
• [3] National Kidney Foundation: Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48:176-247.
• [4] Mudoni A, Cornacchiari M, Gallieni M, Guastoni C, McGrogan D, Logias F, et al. Aneurysms and pseudoaneurysms in dialysis access. Clin Kidney J 2015;8:363-7.
• [5] Belli S, Yabanoglu H, Aydogan C, Parlakgumus A, Yildirim S, Haberal M. Surgical interventions for late complications of arteriovenous fistulas. Int Surg 2014;99:467-74.
• [6] Quinn RR, Lamping DL, Lok CE, Meyer RA, Hiller JA, Lee J, et al. The vascular access questionnaire: assessing patient-reported views of vascular access. J Vasc Access 2008;9:122-8.
• [7] Al-Thani H, El-Menyar A, Al-Thani N, Asim M, Hussein A, Sadek A. Characteristics, management, and outcomes of surgically treated arteriovenous fistula aneurysm in patients on regular hemodialysis. Ann Vasc Surg 2017;41:46-55.
• [8] Berard X, Brizzi V, Mayeux S, Sassoust G, Biscay D, Ducasse E, et al. Salvage treatment for venous aneurysm complicating vascular access arteriovenous fistula: use of an exoprosthesis to reinforce the vein after aneurysmorrhaphy. Eur J Vasc Endovasc Surg 2010;40:100-106.
• [9] Almehmi A, Wang S. Partial aneurysmectomy is effective in managing aneurysm-associated complications of arteriovenous fistulae for hemodialysis: case series and literature review. Semin Dial 2012;25:357-64.
• [10] Chang J, Prema J, Pedersen R, Li Y, Lieb M, Patel K, et al. GIA-Aneurysmorrhaphy and dermal detachment: a novel technique to repair arteriovenous fistula aneurysms. Ann Vasc Surg 2016;33:126-30.
• [11] Watson KR, Gallagher M, Ross R, Severn A, Nagy J, Cochrane L, et al. The aneurysmal arteriovenous fistula–morphological study and assessment of clinical implications. A pilot study. Vascular 2015;23:498-503.
• [12] Vo T, Tumbaga G, Aka P, Behseresht J, Hsu J, Tayarrah M. Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications. J Vasc Surg 2015;61:457-62.
• [13] Powell A, Wooster M, Carroll M, Cardentey-Oliva D, Cavanagh-Voss S, Armstrong P, et al. Long-segment plication technique for arteriovenous fistulae threatened by diffuse aneurysmal degeneration: short-term results. Ann Vasc Surg 2015;29:1327-31.
• [14] Shah AS, Valdes J, Charlton-Ouw KM, Chen Z, Coogan SM, Amer HM, et al. Endovascular treatment of hemodialysis Access pseudoaneuryms. J Vasc Surg 2012;55:1058-62.
• [15] DuBose JJ, Azizzadeh A. Utilization of a tubularized CorMatrix extracellular matrix for repair of an arteriovenous fistula aneurysm. Ann Vasc Surg 2015;29:1-4.
• [16] Hossny A. Partial aneurysmectomy for salvage of autogenous arteriovenous fistula with complicated venous aneurysms. J Vasc Surg 2014;59:1073-7.
• [17] Mewhort HE, Turnbull JD, Meijndert HC, Ngu JM, Fedak PW. Epicardial infarct repair with basic fibroblast growth factor enhanced CorMatrix-ECM biomaterial attenuates postischemic cardiac remodeling. J Thorac Cardiovasc Surg 2014;147:1650-9.
• [18] Patel MS, Street T, Davies MG, Peden EK, Naoum JJ. Evaluating and treating venous outflow stenoses is necessary for the successful open surgical treatment of arteriovenous fistula aneurysms. J Vasc Surg 2015;61:444-8.
• [19] Georgiadis GS, Lazarides MK, Panagoutsos SA, Kantartzi KM, Lambidis CD, Staramos DN, et al. Surgical revision of complicated false and true vascular access-related aneurysms. J Vasc Surg 2008;47:1284-91.