Hasan EKİM, Halil BAŞEL, Dolunay ODABAŞI

Son dönem böbrek yetmezlikli hastalarda görülen arteriyovenöz fistül anevrizmalarının anevrizmorafi yöntemi ile cerrahi tedavisi

Amaç: Bu çalışmada son dönem böbrek yetmezliği (SDBY) olan hastalarda açılan arteriyovenöz fistüllerde (AVF) gelişen anevrizmalara yaklaşım ve cerrahi tedavi yöntemi olarak anevrizmorafinin etkinliği ve güvenilirliği araştırıldı. Çalışma planı: Ocak 2 006 - O cak 2 008 t arihleri a rasında Van Yüksek İhtisas Hastanesi Kalp ve Damar Cerrahisi k liniğinde SDBY’si olan ve AVF a çılan 100 hastadan anevrizma gelişen 15’i (10 erkek, 5 kadın; ort. yaş 36.5±24 yıl; dağılım 29-64 yıl) retrospektif olarak incelendi. Bütün hastalar SDBY ve hemodiyaliz (HD) tedavisi görmekteydi. Hastalar, AVF yerleşim yerleri, işlevsellik ve çapı 4 cm üzerinde olan anevrizmalarda tedavi yöntemi olarak anevrizmorafi ile takip edildi. Bulgular: Fistüllerinde anevrizma gelişen 15 hastanın AVF yerleşim yerleri; iki kişide (%14) sağ radiyal AVF, bir kişide (%6) sağ yüksek radiyal AVF, üç kişide (%20) sağ brakiyal AVF, bir kişide (%6) sol radiyal AVF, üç kişide (%20) sol yüksek radiyal AVF ve beş kişide (%34) sol brakiyal AVF şeklinde idi. Ortalama fistül debisi 768±450 ml/dk idi. Anevrizma gelişen tüm hastalara anevrizmorafi ameliyatı uygulandı. Tüm hastalar ilk 48 saat içinde taburcu edildi. Ameliyat sonrası infeksiyon, hematom, iskemi veya nörolojik hasar gözlenmedi. On beş AVF anevrizmorafi ile tedavi edildi ve 24 ay takip edildi. Sonuç: Anevrizmalar önkola göre brakiyal düzeyde anlamlı bir şekilde daha fazla gelişti. Anevrizma gelişim riskini de göz önünde tutarak, AVF açmak için önkol tercih edilmelidir. Anevrizma gelişmiş olan AVF’ler de AVF’nin işlevselliğini bozmadan anevrizmorafi ile etkin bir şekilde tedavi edilebilir.

Surgical treatment of arteriovenous fistula aneuryms seen in end stage renal failure patients by aneurysmorrhaphy method

Background: In this study we investigated the approach to the aneurysms that develop in arteriovenous fistulas (AVF) performed in end stage renal failure (ESRF) patients and the efficacy and reliability of aneurysmorrhaphy as a surgical treatment method. Methods: Of the 100 patients with ESRF who underwent AVF operations in the Cardiovascular Surgery Department of Van Yüksek İhtisas Hospital between January 2006 and January 2008, 15 patients (10 males, 5 females; mean age 36.5±24 years; range 29 to 64 years) in whom aneurysms developed were retrospectively analyzed. All patients were receiving ESRF treatment and hemodialysis (HD). Patients were followed for AVF localizations, functionality using aneurysmorrhaphy as a treatment modality for aneurysms over 4 cm in diameter. Results: The arteriovenous fistula localizations of 15 patients who developed aneurysms in their AVFs were right radial AVF in two (14%), right high AVF in one (6%), right brachial AVF in three (20%), left radial AVF in one (6%), left high AVF in three (20%), and left brachial AVF in five patients (34%). The mean fistula flow was 768±450 ml/min. All patients who developed aneurysms underwent aneurysmorrhaphy surgery. All patients were discharged within the first 48 hours. There was no infection, hematoma, ischemia, or neurological damage postoperatively. Fifteen AVFs were treated with aneurysmorrhaphy and followed up for 24 months. Conclusion: Aneurysms developed significantly more at the brachial level compared to the forearm. The forearm should be preferred for AVF operations considering the risk of aneurysm development. The AVFs with aneurysms can be effectively treated by aneurysmorrhaphy without jeopardizing the functionality of the fistulas.

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