Treatment of aneurysms of hemodialysis access arteriovenous fistulas

Amaç: Bu çalışmada arteriyovenöz fistül (AVF)’lerde meydana gelen anevrizmaların tamiri ve fistülün devamlılığının sağlanması için kullanılan cerrahi tekniklerin sonuçları sunuldu. Çalışma planı: Antakya Devlet Hastanesi Kalp Damar Cerrahisi Kliniği’nde ve Mustafa Kemal Üniversitesi Göğüs Cerrahisi Anabilim Dalı’nda hemodiyaliz için açılan AVF’lerinde 4 cm ya da üzerinde anevrizması olan toplam 30 hasta (14 erkek, 16 kadın; ort. yaş 52 yıl; dağılım 35-70 yıl) geriye dönük olarak değerlendirildi. Arteriyovenöz fistül 21 hastada radiyosefalik, yedi hastada ise brakiyosefalik idi. Tüm hastalar ameliyattan önce Dopplerli ultrasonografi ile değerlendirildi. Hastaların 28’inde palpe edilebilir pulsatil kitle mevcuttu. Bu hastaların dördünde ilave olarak elde soğukluk ve uyuşma, ikisinde elde ödem ve ciltte laserasyon ve ikisinde NYHA (New York Kalp Birliği) derece 3-4 kalp yetmezliği mevcuttu. Ameliyat yöntemi hastaların arter ve ven yapıları değerlendirilerek belirlendi. Bulgular: Tüm hastalar ameliyattan sonraki birinci günde taburcu edildi. Hematom, iskemi, yara infeksiyonu ya da nörolojik hasar gibi hiçbir komplikasyon gözlemlenmedi. Ameliyattan sonraki ortalama takip süresi 12 aydı. Sonuç: Cerrahi onarım AVF anevrizmaları için altın standart olmaya devam etmektedir. Kliniğimizde uygun olan olgularda anevrizma kesesine plikasyon yöntemi uygulanmaktadır. Bu yöntemin fistülün devamlılığının sağlanmasında etkili olduğuna inanmaktayız.

Hemodiyaliz amaçlı açılan arteriyovenöz fistül anevrizmalarının tedavisi

Background: This study aims to present the results of the surgical techniques employed to repair the aneurysms which occurred in arteriovenous fistulas (AVFs) and to ensure fistula continuity. Methods: A total of 30 cases (14 males, 16 females; mean age 52 years; range 35 to 70 years) with aneurysms of 4 cm or over in AVFs for hemodialysis in Antakya State Hospital, Clinic of Cardiovascular Surgery and Mustafa Kemal University, Department of Thoracic Surgery were evaluated retrospectively. In 21 patients, the AVF was radiocephalic, and in seven it was brachiocephalic. All patients were evaluated with Doppler ultrasonography before surgery. Twenty-eight of the patients had a palpable pulsatile mass. Four of these patients additionally had coldness and hand numbness, two had hand edema and skin lacerations, and two had NHYA (New York Heart Association) degree 3-4 heart failure. The method of surgery was determined by considering the artery and vein structures of the patients. Results: All patients were discharged on the first day after surgery. No complications, such as hematoma, ischemia, wound infection, or neurological damage, were observed. The mean follow-up period after surgery was 12 months. Conclusion: Surgical repair remains the gold standard for AVF aneurysms. In our clinic, the plication method is applied to the aneurysm sac in appropriate cases. We believe that this method is effective to ensure the continuity of the fistula.

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