Akut Arteriovenöz Fistül Trombozunda Cerrahi Trombektominin Yeri ve Sonuçları

Amaç: Popülasyonda arteriovenöz fistül (AVF) trombozu görülme oranları gittikçe artmaktadır ve bu durumda yapılacak kurtarıcı operasyonhakkında görüş birliği sağlanamamıştır. Amacımız AVF trombozu gelişen hastalarda erken dönemde uygulanacak doğru cerrahi işlemin başarıdakirolunü göstermektir.Gereç ve Yöntem: Kasım 2018-Haziran 2020 yılları arasında tek merkezde akut AVF trombozu nedeni ile cerrahi trombektomi operasyonu uygulanmış29 hasta retrospektif olarak analiz edildi. Preoperatif özellikler, perioperatif tanı araçları, cerrahi işlemler ve cerrahi başarı oranları sunuldu.Bulgular: Bütün hastalara trombektomi işlemi uygulanmış olup; 8’ine (%27.5) ek olarak anastomoz bölgesi büyük boy fogarty balon dilatasyonu,3’üne (%10.3) ek olarak anastomoz revizyonu, 5’ine ek olarak tip 2 stenoz bölge eksizyonu ve uç-uca anastomoz uygulandı. Teknik başarı 25 (%86.2)hastada sağlandı. 4 (%13.7) hastaya ise yeni fistül hattı açıldı.Sonuç: Bu sonuçlara göre tecrübeli bir vasküler cerrah tarafından yapılacak erken dönem cerrahi AVF trombektomi uzun dönemde yeterli başarısağlamaktadır. Preoperatif dönemde hastaların ultrasonografi ve bilgisayarlı tomografik anjiografi ile detaylı değerlendirilip trombüsün yeri, tipi,eşlik eden stenozun varlığı ve tipinin belirlenmesi, başarılı hasta seçimi ve cerrahi plan açısından çok önemlidir.

The Place and Outcomes of Surgical Thrombectomy in Acute Arteriovenous Fistula Thrombosis

Objectives: The rate of arteriovenous fistula (AVF) thrombosis has been increasing in the population and there was yet no consensus on the salvage operation to be performed. Our aim is to demonstrate the success of the correct surgical procedure to be applied in the early period in patients with AVF thrombosis. Materials and Methods: Between November 2018 and June 2020, 29 patients who underwent surgical thrombectomy for acute AVF thrombosis in a single center were analyzed retrospectively. Preoperative characteristics, perioperative diagnostic tools, surgical procedures and surgical success were presented. Results: Surgical thrombectomy was performed for all patients. Additionally, balloon dilatation with an oversize fogarty balloon in the anastomosis area was performed for 8 (27.5%) patients, anastomosis revision was performed for 3 (10.3%) patients , type 2 stenosis zone excision and end-toend anastomosis were performed for 5 (17.2%) patients. Technical success was achieved in 25 (86.2%) patients. A new fistula tract was created in 4 (13.7%) patients. Conclusion: According to these results, early surgical AVF thrombectomy performed by an experienced vascular surgeon provides sufficient success in the long term. In the preoperative period, it is very important to evaluate the patients in detail by ultrasonography and computed tomographic angiography and to determine the location and type of thrombus, presence and type of accompanying stenosis for successful patient selection and surgical plan.

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