Evaluation of patency following revision technique ofhigh-velocity arteriovenous fistula

ÜMİT HALICI, MEHMET ALİ KAYGIN, ÖZGÜR DAĞ, AHMET AYDIN, HÜSNÜ KAMİL LİMANDAL, ÜMİT ARSLAN, EYÜP SERHAT ÇALIK, BİLGEHAN ERKUT
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Abstract


Background/aim: The objective of this study is to report our experience with surgical revision of dialysis access-induced ischemia syndrome. Materials and methods: Between January 2005 and July 2013, 1254 patients underwent arteriovenous fistula operation, and 86 of them [53 males, mean age: 55 ± 25 (range: 25 to 75) years; 33 females, mean age: 50 ± 20 (range: 30 to 70) years] subsequently developed steal syndrome. These patients were treated with arterial pressure-controlled polytetrafluoroethylene banding or constriction with polypropylene suturing technique. Patients were followed in the outpatient clinic at regular intervals. Results: Symptoms were not relieved during the first 15 days in 4 patients; therefore, reintervention was performed. Thrombosis occurred in one patient after reintervention. No early or late complications were detected in other patients, and fistulae were suitable for hemodialysis. Patency rates at 6 and 12 months were 96% and 92%, respectively, and thrombosis rates were 7% and 9%. There was no hospital mortality in our study, but one patient died from unrelated causes and two other patients quit follow-up after 6 months. Conclusion: We think that arterial pressure-controlled surgical revision is an effective and safe technique in patients with fistula-related hand ischemia.

Keywords


Hemodialysis, arteriovenous fistula, hand ischemia, banding technique

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References


Shah R, Bhatt UY, Cleef SV, Farley M, Davis A, Swope M Agarwal AK. Vascular access thrombosis and interventions in patients missing haemodialysis sessions. Clin Nephrol 2011; 76: 435–439.

Shah R, Vachharajani TJ, Agarwal AK. Aneurysmal dilatation of dialysis arteriovenous access. Open Urology & Nephrology Journal 2013; 6: 1–5.

Fokou M, Teyang A, Ashuntantang G, Kaze F, Eyenga VC, Chichom Mefire A, Angwafo F 3rd. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg 2012; 26: 680–684.

Rogers NM, Lawton PD. Ischaemic monomelic neuropathy in a non-diabetic patient following creation of an upper limb arteriovenous fistula. Nephrol Dial Transplant 2006; 22: 933– 935.

Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischaemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 2004; 27: 1–5.

Schanzer H, Eisenberg D. Management of steal syndrome resulting from dialysis access. Semin Vasc Surg 2004; 17: 45– 49.

Ravani P, Spergel LM, Asif A, Roy-Chaudhury P, Besarab A. Clinical epidemiology of arteriovenous fistula in 2007. J Nephrol 2007; 20: 141–149.

Leon C, Asif A. Arteriovenous access and hand pain: the distal hypoperfusion ischemic syndrome. Clin J Am Soc Nephrol 2007; 2: 175–183.

Regalado S, Navuluri R, Vikingstad E. Distal revascularization and interval ligation: a primer for the vascular and interventional radiologist. Semin Intervent Radiol 2009; 26: 125–129.

Spergel LM, Ravani P, Roy-Chaudhury P, Asif A, Besarab A. Surgical salvage of the autogenous arteriovenous fistula (AVF). J Nephrol 2007; 20: 388–398.

Stolic RV, Mijailovic MZ, Cvetkovic AM, Stanojevic MS, Stolic DZ, Cvetkovic DM. Distal ischemia induced by vascular access for hemodialysis-a case report. Hippokratia 2012; 16: 375–377.

Zanow J, Kruger U, Scholz H. Proximalization of the arterial inflow: a new technique to treat access-related ischemia. J Vasc Surg 2006; 43: 1216–1221.

Asif A. Nephrologists and interventional nephrology. Dialysis Transplant 2010; 39: 476–480.

Mickley V. Steal syndrome--strategies to preserve vascular access and extremity. Nephrol Dial Transplant 2008; 23: 19–24.

Wixon CL, Mills JL, Berman SS. Distal revascularization- interval ligation for maintenance of dialysis access and restoration of distal perfusion in ischemic steal syndrome. Semin Vasc Surg 2000; 13: 77–82.

DeCaprio JD, Valentine RJ, Kakish HB, Awad R, Hagino RT, Clagett GP. Steal syndrome complicating hemodialysis access. Cardiovasc Surg 1997; 5: 648–653.

Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and characteristics of patients with hand ischaemia after a hemodialysis access procedure. J Surg Res 1998; 74: 8–10.

Odland MD, Kelly PH, Ney AL, Anderson RC, Bubrick MP. Management of dialysis associated steal syndrome complicating upper extremity arteriovenous fistulas: use of intraoperative digital photoplethysmography. Surgery 1991; 110: 664–669.

van Hoek F, Scheltinga M, Luirink M, Pasmans H, Beerenhout C. Banding of hemodialysis access to treat hand ischemia or cardiac overload. Semin Dial 2009; 22: 204–208.

Hastaoğlu IA, Parlar H, Toköz H, Bilgen F. Ischemic syndrome due to distal hypoperfusion in hemodialysis arteriovenous fistulas. Turkish J Thorac Cardiovasc Surg 2013; 21: 936–943 (in Turkish with English abstract).

Özbek İC, Kocailik A, Sever K, Mansuroğlu D. Treatment of dialysis access-associated steal syndrome with pressure monitorization-assisted PTFE banding. Turkish J Thorac Cardiovasc Surg 2011; 19: 182–185 (in Turkish with English abstract).

Meyer F, Muller JS, Grote R, Halloul Z, Lippert H, Bürger T. Fisteldrosselung-erfolgversprechendes Konzept bei peripherer Minderperfusion. Zentralbl Chir 2002; 127: 685–688 (in German).

Rivers SP, Scher LA, Veith FJ. Correction of steal syndrome secondary to hemodialysis fistulas: a simplified quantitative technique. Surgery 1992; 112: 593–597.