Modified Staple Aneurysmorrhaphy for Treating Arteriovenous Fistula-Related Venous Aneurysms

Midterm outcomes of arteriovenous fistula aneurysm repair with simultaneous inflow revision or outflow tract revascularization

OBJECTIVE

The aim of this study was to investigate the 2-year outcomes of extensive revisions aimed at simultaneously addressing arteriovenous fistula (AVF) aneurysms, outflow stenosis, and/or high flow volumes.

METHODS

This was a retrospective cohort study in a tertiary referral center. The study population comprised hemodialysis patients with aneurysmal AVFs requiring revision. Subjects were eligible if they were ≥18 years of age and had aneurysm repair associated with inflow revision or treatment of outflow lesions. Patients were followed-up for a minimum of 2 years, and the primary outcome measure was cumulative patency.

RESULTS

Our cohort comprised 93 patients with a mean age of 56 ± 12 years. The most frequent access type was brachiocephalic fistula (61%), and the median access age at the time of revision was 66 months (interquartile range, 46-93 months). The median access flow volume was 2300 ml/min (interquartile range, 1281-2900), and 31 subjects (33%) presented aneurysms associated with both high flow and venous obstruction. Aneurysm repair consisted of aneurysmorraphy in the overwhelming majority (95%). Inflow revision was performed in a total of 49 cases (53%), and outflow tract obstruction was treated in 71 patients (72%), with 27 patients (29%) receiving a simultaneous 3-component revision. At 2 years, the primary, primary assisted, and cumulative patencies were 60% ± 1%, 91% ± 3%, and 94% ± 3%, respectively. The most frequent indication for first-time reinterventions was outflow tract stenosis (24%). Aneurysm recurrence was observed in 13 subjects (14%) during the entire follow-up and was responsible for reinterventions in seven of them (8%), with a 2-year freedom from aneurysm-related reintervention rate of 95% ± 3%.

CONCLUSIONS

Extensive AVF revision with simultaneous aneurysm repair, inflow revision, and outflow tract revascularization is feasible, safe, and associated with favorable 2-year patency rates.

Analysis of Different Vascular Accesses on Dialysis Quality and Infection Risk Factors of Hemodialysis Patients

Objective

To explore the influence of different vascular accesses on dialysis quality and infection risk factors of hemodialysis patients.

Methods

A total of 162 patients with end-stage renal disease admitted to our hospital from February 2018 to July 2020 were divided into two groups: cuff tunnel conduit (CTC) group and native arteriovenous fistula (AVF) group. Peripheral blood was collected before and 6 months after dialysis. The incidence of vascular recirculation was measured, and the risk factors of infection were analyzed.

Results

The levels of HB, Alb, CRP, BUN, Scr, and TP after dialysis in the two groups were lower than those before dialysis (P < 0.05). The Kt/V of patients in both groups did not exceed 1.2, and the URR value exceeded 60%. The results of independent-samples T test analysis documented that the Kt/V level of patients in the AVF group was higher than that of those in the CTC group after dialysis (P < 0.05). The results of the urea method revealed that 22 of 68 patients (32.35%) in the CVC group and 21 of 94 (22.34%) in the AVF group had vascular pathway recirculation. The χ² test showed that there was no remarkable difference in the incidence of vascular pathway recirculation between both groups (P > 0.05). However, the results of the nonurea method revealed that the incidence of vascular pathway recirculation in the AVF group was lower than that in the CVC group (P < 0.05). Multivariate logistic regression was used to further analyze the factors with statistical significance in the single factor results. It showed that age >60 years, dialysis duration >1 year, dialysis times, diabetes, hypertension, and CTC were all independent risk factors causing vascular access infection.

Conclusion

If all conditions permit, AVF hemodialysis is a better choice for patients with end-stage renal disease. For the elderly, long-term hemodialysis, and those with diabetes and hypertension, it is necessary to make detailed plans, strengthen the operation proficiency of CTC, and reduce the incidence of infection.

Sleeve Fistulectomy: A Novel Hybrid Technique to Manage the Degenerative Arteriovenous Fistula

Aneurysmal degeneration following long-term access is an important problem associated with an arteriovenous fistula (AVF) and can result in rupture, thrombosis, or the need for ligation. We describe five patients receiving hemodialysis through large degenerative brachiocephalic AVFs who underwent successful revision and avoided the need for a temporary dialysis catheter. A hybrid approach using an open surgical technique with both endovascular and laparoscopic tools provides an opportunity to maintain patency and restore function by combining modern surgical tools.

Partial aneurysmectomy for treatment of autologous hemodialysis fistula aneurysm is safe and effective

OBJECTIVE

The purpose of this study was to evaluate the outcome and the factors associated with stenosis after treatment using partial aneurysmectomy for aneurysm in autologous arteriovenous fistulas.

METHODS

This retrospective cohort study was conducted from July 2007 to June 2016 and included patients with complicated aneurysms in upper extremity autologous arteriovenous fistulas were treated by partial aneurysmectomy. Vascular ultrasound examination was performed every 6 months after the surgery.

RESULTS

Forty-one patients (median age, 37 years; 70.7% males) were included. Of the patients, 95.1% had a radial-cephalic fistula in the forearm and nearly 88% had 1 or 2 aneurysms in arteriovenous fistulas that had been created for 10 to 84 months. Technical success of partial aneurysmectomy was achieved in all patients. The access diameter (44.0 ± 5.1 mm vs 10.4 ± 1.8 mm; P < .01) and brachial artery blood flow (1618.2 ± 277.0 mL/min vs 772.1 ± 127.4 mL/min; P < .01) were significantly decreased after the surgery. The median follow-up time was 27 months (range, 12-43 months). The primary patency rates at 6 and 12 months were 100% and 95%, respectively. Loss of patency was due to stenosis of the remodeled fistulas, which occurred in seven patients (17%). Multivariate COX regression analysis revealed that diabetes (hazard ratio, 114.28; 95% confidence interval, 2.85-4583.94; P = .01) was a risk factor for the impaired primary patency rates. A larger postprocedure residual diameter trended to favor fistula patency (hazard ratio, 0.46; P = .07). Stenosis was successfully treated with percutaneous transluminal angioplasty.

CONCLUSIONS

Partial aneurysmectomy is an effective and safe method for treating aneurysm of upper extremity autologous arteriovenous fistulas, leading to good 12-month primary patency and no aneurysm recurrence. Using a larger catheter to size the revised fistula during aneurysmectomy may increase access patency.