Tolga KURT, Özer KANDEMİR, Mustafa BÜYÜKATEŞ, S.Akın TURAN, Elif CEYLAN

Hemodiyaliz amaçlı gerçekleştirilen ardışık 165 nativ arteriyovenöz fistül operasyonunun retrospektif değerlendirilmesi

Bu çalışmanın amacı hemodiyaliz amaçlı arteriyovenöz fistül operasyonlarındaki deneyimlerimizi, başarı oranlarımızı ve cerrahi teknikleri değerlendirmektir. Hastalar ve Yöntem: Ocak 2003 ile Aralık 2005 tarihleri arasında hemodiyaliz amacıyla gerçekleştirdiğimiz ardışık 165 arteriyovenöz fistül operasyonunu retrospektif olarak değerlendirdik. Değerlendirme operasyonun tipine, gerçekleştirildiği lokalizasyona ve komplikasyonlara göre yapıldı. Bulgular: Bu ardışık 165 operasyonluk seride greft kullanılmadı. 6 aylık açık kalma oranı Snuffbox, Radiyosefalik ve Brakiyosefalik fistüller için sırasıyla %90, %93 ve %93’dür. Komplikasyon oranı %13 olup en sık görülen komplikasyon trombus oluşumudur. Sonuç: Bütün fistüllerde amaç verimli olması ve uzun süre çalışması olmalıdır. Brakiyosefalik fistüllerin açıklık oranları radiyosefalik fistüllere benzerdir. Nativ fistüller hem kolda hem de önkolda başarılı, güvenli ve kolay olarak gerçekleştirilebilirler.

Retrospective evaluation of consecutive 165 native arteriovenous fistula operations performed for haemodialysis access

The aim of this study was to evaluate our arteriovenous fistula experience and success rate and the surgical technique in arteriovenous fistula operations for haemodialysis access. Methods: We retrospectively reviewed 165 consecutive operations for haemodialysis access performed in our department from January 2003 to December 2005. They were evaluated for the type of operation, localization and complications. Results: No grafts were used in this series of 165 consecutive operations. The 6-month patency rates of native fistulas were 90%, 93% and 93% for the snuffbox, radiocephalic and brachiocephalic fistulas, respectively. The complication rate was 13% and the most common complication was thrombus formation. Conclusion: For all arteriovenous fistulas, the aim should be a long duration of patency and productivity. Patency rates of brachiocephalic fistulas are comparable to those of radiocephalic fistulas. Native fistulas are reliable, safe and simple procedures with access sites often available in both the forearm and the upper arm.

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1. Albers F. Causes of hemodialysis access failure. Adv Ren Replace Ther 1994; 1: 107-18.
2. Konner K. The initial creation of native arteriovenous fistulas: surgical aspects and their impact on the practice of nephrology. Semin Dial. 2003; 16: 291-8.
3. Johnson MS. Percutaneous placement and management of hemodialysis catheters. In: Savader SC, Trerotola SO (eds). Venous Interventional Radiology with Clinical Perspectives. 2nd ed. New York: Thieme, 2000: 301-14.
4. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966; 17; 275(20): 1089-92.
5. Haimovici H, Steinman C, Caplan LH. Role of arteriovenous anastomoses in vascular diseases of the lower extremity. Ann Surg. 1966; 164: 990-1002.
6. Burger H, Kootstra G, de Charro F, Leffers P. A survey of vascular access for haemodialysis in The Netherlands. Nephrol Dial Transplant 1991; 6: 5-10.
7. Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: metaanalysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg. 2004; 28: 583-9.
8. Wolowczyk L, Williams AJ, Donovan KL, Gibbons CP. The snuffbox arteriovenous fistula for vascular access. Eur J Vasc Endovasc Surg. 2000; 19: 70-6.
9. Maya ID, Oser R, Saddekni S, Barker J, Allon M. Vascular access stenosis: comparison of arteriovenous grafts and fistulas. Am J Kidney Dis. 2004; 44: 859-65.
10. Zeebregts CJ, Tielliu IF, Hulsebos RG, de Bruin C, Verhoeven EL, Huisman RM, van den Dungen JJ. Determinants of failure of brachiocephalic elbow fistulas for haemodialysis. Eur J Vasc Endovasc Surg. 2005; 30: 209-14.
11. Jennings WC. Creating arteriovenous fistulas in 132 consecutive patients: exploiting the proximal radial artery arteriovenous fistula: reliable, safe, and simple forearm and upper arm hemodialysis access. Arch Surg. 2006; 141: 27-32; discussion 32.
12. Dix FP, Khan Y, Al-Khaffaf H. The brachial artery-basilic vein arterio- venous fistula in vascular access for haemodialysis—a review paper. Eur J Vasc Endovasc Surg. 2006; 31: 70-9.
13. Bonforte G, Zerbi S, Surian M. The middle-arm fistula: A new native arteriovenous vascular access for hemodialysis patients. Ann Vasc Surg. 2004;18(4):448-52.
14. Bruns SD, Jennings WC. Proximal radial artery as inflow site for native arteriovenous fistula. J Am Coll Surg. 2003; 197: 58-63.
15. Bonalumi U, Civalleri D, Rovida S, Adami GF, Gianetta E, Griffanti- Bartoli F. Nine years’ experience with end-to-end arteriovenous fistula at the ‘anatomical snuffbox’ for maintenance haemodialysis. Br J Surg. 1982; 69: 486-8.
16. Senkaya I, Aytac II, Ercan AK, Aliosman A, Percin B. The graft selection for haemodialysis. Vasa. 2003; 32: 209-13.
17. Sulkowski U, Schulte H. Arguments in favour of a homologous concept for hemodialysis access procedures. Feasibility and results. Eur J Vasc Endovasc Surg. 2003; 26: 96-9.
18. Lazarides MK, Iatrou CE, Karanikas ID, Kaperonis NM, Petras DI, Zirogiannis PN, Dayantas JN. Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur J Surg. 1996; 162: 297-301.
19. Tordoir JH, Hofstra L, Leunissen KM, Kitslaar PJ. Early experience with stretch polytetrafluoroethylene grafts for haemodialysis access surgery: results of a prospective randomised study. Eur J Vasc Endovasc Surg. 1995; 9: 305-9.
20. Okadome K, Komori K, Fukumitsu T, Sugimachi K. The potential risk for subclavian vein occlusion in patients on haemodialysis. Eur J Vasc Surg. 1992; 6: 602-6.
21. Murphy GJ, White SA, Nicholson ML. Vascular access for haemodialysis. Br J Surg. 2000; 87: 1300-15. Review.
22. Lazarides MK, Staramos DN, Panagopoulos GN, Tzilalis VD, Eleftheriou GJ, Dayantas JN. Indications for surgical treatment of angioaccess- induced arterial “steal”. J Am Coll Surg. 1998; 187: 422-6.
23. Henriksson AE, Bergqvist D. Steal syndrome of the hemodialysis vascular access: diagnosis and treatment. J Vasc Access. 2004; 5: 62-8.
24. Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg. 2004; 27: 1-5. Review.
25. Nguyen DQ, Ruddle AC, Thompson JF. Late axillo-brachial arterial aneurysm following ligated Brescia-Cimino haemodialysis fistula. Eur J Vasc Endovasc Surg. 2001; 22: 381-2.
26. Vogel KM, Martino MA, O’Brien SP, Kerstein MD. Complications of lower extremity arteriovenous grafts in patients with end-stage renal disease. South Med J. 2000; 93: 593-5.
27. Donovan K. Population requirements for vascular access surgery. Eur J Vasc Endovasc Surg. 2006; 31: 176-80.