Oya RENDECİ, Tayfun GÖKTOĞAN, Engin TULUKOĞLU, Ahmet BALTALARLI, Gökhan ÖNEM, İbrahim GÖKŞİN, Mustafa SAÇAR, Hakan KARA

Arteriyovenöz fistül operasyonları: Erken ve geç dönemde revizyon gerektiren komplikasyonlar

Amaç: Kronik böbrek hastaları hemodializ işlemi için, düşük komplikasyon oranına sahip ve uzun süre açık kalabilen kalıcı arteriyovenöz (AV) fistüllere gereksinim duyarlar. Bu çalışmada amacımız; AV fistül operasyonları sonrası erken ve geç dönemde cerrahi revizyon gerektiren komplikasyonları belirlemekti. Materyal ve Metod: Çalışmaya, Pamukkale Üniversitesi Tıp Fakültesi ve İzmir Atatürk Eğitim ve Araştırma Hastanesi Kalp Damar Cerrahisi Klinikleri'nde Ocak 1990 ve Ekim 1999 yılları arasında arteriyovenöz fistül operasyonu uygulanan ve erken dönem (ilk 48 saat) AV fistül komplikasyonu nedeniyle revizyon uygulanan 22 hasta (Grup 1) ile aynı kliniklere Eylül 1998 ve Ekim 1999 tarihleri arasında AV fistül operasyonlarının geç dönem komplikasyonları ile başvuran ve revizyon uygulan 33 hasta (Grup 2) dahil edildi. Bulgular: Grup l'deki toplam 22 hastanın; ll'inde tromboz (%50), 8'inde hematom (%36.4) ve 3'ünde hemoraji (%13.6) nedeniyle revizyon uygulanırken, Grup 2'deki toplam 33 hastanın; 26'smda fistül trombozu (%79), 2'sinde ödem (%6),sinde arteriyal steal (%3), 3'ünde pseudoanevrizma (%9), sinde greft trombozu (%3) ve greft infeksiyonu (%3) nedeniyle revizyon uygulandı. Sonuç: Arteriyovenöz fistül operasyonları sonrası en sık görülen komplikasyon fistül trombozudur. Kronik böbrek hastalarında, primer ve sekonder fistül açıklığını maksimize edecek stratejiler geliştirilebilir, diyaliz süresi uzatılabilir ve hasta morbiditesi ve mortalitesi azaltılabilir.

Arteriovenous fistula operations: Its early and late-term complicaitons that need to revision

Background: A patients with chronic renal disaese for haemodialysis require a permanent arteriovenous fistulas (AVFs) which has a good long-term patency and a low complication rate. The objective of this study was to determine early and late-term complications of AVFs that need to surgical revision. Methods: Twentytwo patients (called as Group 1) who operated from early (first 48 hours) complications of AVFs during the period between january'90 and october'99 in Cardiovasculary Surgery Departments in Pamukkale University and İzmir Atatürk Education and Traning Hospitals was included to this study. Also, 33 patients (called as Group 2) admitting to our hospital from late-term complications of AVFs that need to surgical revision during the period between september'98 and october'99 was included to this study. Results: Surgical revision was performed in 11 patients (50%) due to thrombosis, in 8 patients (%36.4) due to hemaetom and in 3 patients (13.6%) due to hemorrhage in Group 1. Surgical revision was performed in 26 patients (79%) due to thrombosis, in 2 patients (%6) due to oedema, in 1 patients (3%) due to arterial steal, in 3 patients (9%) due to peudoaneurysm and in 1 patients (3%) due to graft thrombosis and graft infection in Group 2. Conclusions: Fistula thrombosis is the most common complication of AVFs. Anew strategies can be devoloped in order to maximize primary and secondary fistula patency and to prolong the use of AVFs and to decrease morbidity and mortality of the patients with AVFs.

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