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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 October;26(5):345-9
Surgical treatment for complications of arteriovenous fistulas in hemodialysis patients
Ilhan G., Bozok Ş., Destan B., Karamustafa H., Ozan Karakisi S., Ergene Ş., Tüfekci N., Aslan C.
Department of Cardiovascular Surgery Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Rize, Turkey
Aim: The aim of this paper was to evaluate both the incidence of complications developed secondary to arteriovenous fistulas performed with autogenous vein grafts in upper extremities, and also the indications for surgical repair in hemodialysis patients.
Methods: Arteriovenous fistulas opened at wrist, and antecubital region, primary patency rate, indication for reoperation (rates of reoperation because of thrombosis, and stenosis), and surgical repair (primary repair, banding, thrombectomy, bypass, etc.), and complications like hematoma, hemodialysis access site infection, pseudoaneurysm secondary to intervention, development of venous aneurysm, serious edema due to higher shunt performed above arteriovenous fistula, ischemia, and contracture were retrospectively evaluated.
Results: Nine hundred and eighty arteriovenous fistulas were opened in 886 patients with established diagnoses of chronic renal failure. Early-stage or late-stage shunt occlusion is the major reason for failure of all types of fistulas. Patency rates for the first 3 months were found to be 78-87% for radiocephalic, and 92-98% for antecubital fistulas (brachiocephalic artery-basilic or antecubital vein fistulas). Other complications were hematoma, venous aneurysm, edema secondary to venous hypertension, infection of the dialysis access site, pseudoaneurysm secondary to intervention, hand ischemia, and contracture.
Conclusion: Awareness and provision of optimal conditions for hemodialysis access, elimination of developing complications by appropriate surgical treatment will increase both long-term uneventful patency rates of endogenous arteriovenous fistulas and also quality of lives of the patients.