Vascular complications of native arteriovenous fistulas for hemodialysis: Role of microsurgery

Abstract

This article describes the treatment of 56 early and late vascular complications of native arteriovenous fistula (AVF) in patients with end-stage renal disease, between January 1987 and January 1999. Twenty-six were arteriovenous aneurysms and 2 pseudoaneurysms; 25 were thromboses. We also observed two cases of periarteritis associated with systemic lupus erythematosus (SLE) and one complex iatrogenic lesion caused by an attempt at percutaneous restoration of potency. We applied microsurgical principles, instruments, and techniques. It was possible to restore a vascular access at the original site, using the same vessels in 45 cases (80.4%). In 10.7% of cases, we were able to rescue the original AVF by microsurgical revision. A new vascular access had to be created proximally in the same limb or in the contralateral forearm in 11 cases of aneurysms (19.6% of the total, 42% of the aneurysms). After a minimum follow-up of 8 months, a total of four patients had to be reoperated for further complications (7.2%). Our data support the idea that microsurgical treatment of vascular complications of native AVF is highly successful compared with results obtained by conventional surgery and, in a defined subgroup of patients, permits salvage of the fistula.Si descrive il trattamento di 56 complicanze vascolari precoci e tardive di fistole arterovenose in pazienti uremici, fra il gennaio 1987 ed il gennaio 1999: ventisei aneurismi arterovenosi, 2 pseudoaneurismi e 25 trombosi. Abbiamo anche osservato due casi di periarterite associata a LES ed una complessa lesione iatrogena causata durante un tentativo di disostruzione percutanea. Abbiamo applicato i principi, gli strumenti e le tecniche della Microchirurgia. È stato possibile ripristinare un accesso nel sito originario, utilizzando gli stessi vasi, in 45 casi (80.4%). Nel 10.7% dei casi si è potuta recuperare la fistola originaria per mezzo di una revisione microchirurgica. In 11 casi di aneurisma (19.6% del totale, 42% degli aneurismi) è stato creato un nuovo accesso vascolare prossimalmente nello stesso lato o sull'altro avambraccio. Dopo un follow-up minimo di 8 mesi, il 7.2% dei pazienti è stato rioperato per ulteriori complicanze. I nostri dati supportano l'idea che il trattamento microchirurgico delle complicanze vascolari delle fistole arterovenose sia estremamente efficace in confronto ai risultati della chirurgia convenzionale, consentendo in un sottogruppo di pazienti il salvataggio della fistola originaria.

Aberrant Ulnar Artery and Ulnar Artery Thrombosis with Nerve Entrapment: A Case Report and Review of Literature

“…Comparing both types of aneurysms, it can be concluded that this patient had a true aneurysm, based on the size of dilation which is three times larger than native size (over 2 cm) [19]. Patients who experience AVF aneurysm have additional risk factors which include hypertension, hypotension, immunologic disease, diabetes mellitus, arteriolosclerosis, early puncture of AVF site, repeated punctures, and mechanical compression [20,21]. True aneurysm; however take years to occur after fistula creation, with a mean time of 47 months [19].…”

Midterm results of salvage surgery for autogenous dialysis access in aneurysmal arteriovenous fistulas

“…AVF aneurysms are associated with a high rate of complications, such as stenosis, thrombosis, and infection [3]. Consequently, it is essential to manage VARAs to preserve VA, but they are difficult to salvage, and conservative management can be challenging.…”

“…Kidney replacement therapies for patients with end-stage renal failure include peritoneal dialysis, hemodialysis and kidney transplantation [1]. Creating an arteriovenous fistula (AVF) requires surgeon skill and experience, but provides comfort and safety for the patient [2,3]. Creating an autologous AVF for hemodialysis patients is considered the best treatment method [4].…”

Late postoperative complications of arteriovenous fistula for hemodialysis

“…Large differences in the frequency of complications in some studies also indicate differences in the frequency of some risk factors. In addition to demographic characteristics of patients, the occurrence of certain complications depends on the underlying kidney disease, the presence of comorbid conditions or various metabolic and immune disorders that occur in chronic renal failure and have already been mentioned in the pathogenesis of AVF stenosis and thrombosis [7,8,28]. Recently, Gardeezi et al [35] have shown that low concentration of 25(OH)D and high concentration of FGF-23 and parathormone were associated with a higher risk for AVF reinterventions.…”

“…Differences in the frequency of each complication can be explained by differences in surgical technique, AVF localization, diagnostic methods, but, above all, differences in the characteristics of patients and the quality of their blood vessels. It has been described that the age of patients, sex, underlying disease, comorbidities, but also the use and care of AVF significantly affect the occurrence of complications and survival of AVF [4,8,16].…”