İsmail Oral HASTAOĞLU, Hakan PARLAR, Hamdi TOKÖZ, Fuat BİLGEN

Hemodiyaliz amaçlı arteriyovenöz fistüllerde distal hipoperfüzyona bağlı iskemik sendrom

Amaç: Bu çalışmada çalma sendromunun nedenleri,önlenmesi ve tedavi yöntemleri değerlendirildi.Çalışma planı: Hastanemiz kalp ve damar cerrahisi bölümünde 2008 Ocak - Eylül 2012 tarihleri arasında tedaviedilen 36 hasta (23 erkek, 13 kadın; ort. yaş 58.3 yıl; dağılım 43-77 yıl) retrospektif olarak incelendi. Bulg ul ar: Hastaların 19’u (%52.7) diyabetik idi.Fistüller 21 hastada (%58.3) antekübital bölgede yerleşimli iken, diğer fistüller ön kolda distal yerleşimli idi.Dört hastada (%11.1) distal revaskülarizasyon interval ligasyon, sekiz hastada (%22.2) banding, dört hastada (%11.1) anastomoz ve dilate ven segmenti plikasyonu, beş hastada (%13.8) 6 mm PTFE greft (4-6 cm boyunda)interpozisyonu ve sekiz hastada (%22.2) distal radialarter ligasyonu uygulandı. Dört hastada (%11.1) banding işlemi radial arter ve yan dal ligasyonları ile birlikteuygulandı. Üç hastada (%8.3) ise, distal giriş kullanılarak revizyon cerrahisi uygulandı. Hiçbir hastada işlemsonrası tril kaybı görülmedi. Bir hasta dışında kateter gereksinimi olmadı. Ortalama takip süresi 10.9 ay(dağılım 1-28 ay) olarak bulundu. Beş hastada (%13.8)işlem başarısız oldu. Otuz bir hastanın (%86.1) yakınmaları ise tam olarak düzeldi.Sonuç: Diyalize bağlı çalma sendromlarında uygun revizyon teknikleri ile hastaların mevcut arteriyovenöz fistülleri korunarak, yüksek oranda diyaliz devamlılığının sürdürülebileceğini düşünüyoruz.

Ischemic syndrome due to distal hypoperfusion in hemodialysis arteriovenous fistulas

Background: This study aims to evaluate the reasons for steal syndrome and preventive and therapeutic modalities. Methods: Thirty-six patients (23 males, 13 females; mean age 58.3 years; 43 to 77 years) who were treated in our cardiovascular outpatient clinic between January 2012 and September 2012 were retrospectively analyzed. Results: Nineteen of the patients were diabetic (52.7%). Fistulas were located in the antecubital region in 21 patients (58.3%), while others were located in the distal forearm. We performed distal revascularization interval ligation in four patients (11.1%), banding in eight patients (22.2%), plication of anastomosis and dilated venous segment in four patients (11.1%), interposition of 6 mm PTFE graft in five patients (13.8%) and ligation of distal radial artery in eight patients (22.2%). Ligation of radial artery and lateral branches with banding was administered in four patients (11.1%). Three patients (8.3%) underwent revision surgery by using distal inflow. None of the patients had loss of thrill following the procedure. No catheter was required except for one patient. The mean follow-up was 10.9 months (range 1-28 months). The procedure failed in five patients (13.8%). The complaints were completely recovered in 31 patients. Conclusion: We conclude that the continuity of dialysis can be highly sustained in patients with steal syndrome due to dialysis, maintaining the current arteriovenous fistulas through appropriate revision techniques.

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