Akut Arteriovenöz Fistül Trombozunda Cerrahi Trombektominin Yeri ve Sonuçları

Year 2020, Volume: 73 Issue: 3, 261 - 265, 27.10.2020

Fatih Gümüş

Abstract

Amaç: Popülasyonda arteriovenöz fistül (AVF) trombozu görülme oranları gittikçe artmaktadır ve bu durumda yapılacak kurtarıcı operasyon hakkında görüş birliği sağlanamamıştır. Amacımız AVF trombozu gelişen hastalarda erken dönemde uygulanacak doğru cerrahi işlemin başarıdaki rolunü göstermektir.

Gereç ve Yöntem: Kasım 2018-Haziran 2020 yılları arasında tek merkezde akut AVF trombozu nedeni ile cerrahi trombektomi operasyonu uygulanmış 29 hasta retrospektif olarak analiz edildi. Preoperatif özellikler, perioperatif tanı araçları, cerrahi işlemler ve cerrahi başarı oranları sunuldu.

Bulgular: Bütün hastalara trombektomi işlemi uygulanmış olup; 8’ine (%27.5) ek olarak anastomoz bölgesi büyük boy fogarty balon dilatasyonu, 3’üne (%10.3) ek olarak anastomoz revizyonu, 5’ine ek olarak tip 2 stenoz bölge eksizyonu ve uç-uca anastomoz uygulandı. Teknik başarı 25 (%86.2) hastada sağlandı. 4 (%13.7) hastaya ise yeni fistül hattı açıldı.

Sonuç: Bu sonuçlara göre tecrübeli bir vasküler cerrah tarafından yapılacak erken dönem cerrahi AVF trombektomi uzun dönemde yeterli başarı sağlamaktadır. Preoperatif dönemde hastaların ultrasonografi ve bilgisayarlı tomografik anjiografi ile detaylı değerlendirilip trombüsün yeri, tipi, eşlik eden stenozun varlığı ve tipinin belirlenmesi, başarılı hasta seçimi ve cerrahi plan açısından çok önemlidir.

Keywords

Arteriovenous Fistül, Thrombozis, Cerrahi Trombektomi

Ethical Statement

Çalışma için Zonguldak Bülent Ecevit Üniversitesi Etik Kurulu’ndan onay alındı (tarih: 05/08/2020, no: 2020/16).

Supporting Institution

-

Project Number

-

Thanks

-

The Place and Outcomes of Surgical Thrombectomy in Acute Arteriovenous Fistula Thrombosis

Abstract

Objectives: The rate of arteriovenous fistula (AVF) thrombosis has been increasing in the population and there was yet no consensus on the salvage operation to be performed. Our aim is to demonstrate the success of the correct surgical procedure to be applied in the early period in patients with AVF thrombosis.

Materials and Methods: Between November 2018 and June 2020, 29 patients who underwent surgical thrombectomy for acute AVF thrombosis in a single center were analyzed retrospectively. Preoperative characteristics, perioperative diagnostic tools, surgical procedures and surgical success were presented.

Results: Surgical thrombectomy was performed for all patients. Additionally, balloon dilatation with an oversize fogarty balloon in the anastomosis area was performed for 8 (27.5%) patients, anastomosis revision was performed for 3 (10.3%) patients , type 2 stenosis zone excision and end-toend anastomosis were performed for 5 (17.2%) patients. Technical success was achieved in 25 (86.2%) patients. A new fistula tract was created in 4 (13.7%) patients.

Conclusion: According to these results, early surgical AVF thrombectomy performed by an experienced vascular surgeon provides sufficient success in the long term. In the preoperative period, it is very important to evaluate the patients in detail by ultrasonography and computed tomographic angiography and to determine the location and type of thrombus, presence and type of accompanying stenosis for successful patient selection and surgical plan.

Keywords

Arteriovenous Fistula, Thrombosis, Surgical Thrombectomy

Ethical Statement

Çalışma için Zonguldak Bülent Ecevit Üniversitesi Etik Kurulu’ndan onay alındı (tarih: 05/08/2020, no: 2020/16).

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-352.
• 2. Cho S. The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist. Kidney Res Clin Pract. 2017;36:175-181.
• 3. Iverson RE, Gomez JL. Deep venous thrombosis: prevention and management. Clin Plast Surg. 2013;40:389-398.
• 4. Guanella R. [Post-thrombotic syndrome: the forgotten complication of venous thromboembolism]. Rev Med Suisse. 2013;9:321-325.
• 5. Rabin I, Shani M, Mursi J, et al. Effect of timing of thrombectomy on survival of thrombosed arteriovenous hemodialysis grafts. Vasc Endovascular Surg. 2013;47:342-345.
• 6. Tessitore N, Mansueto G, Lipari G, et al. Endovascular versus surgical preemptive repair of forearm arteriovenous fistula juxta-anastomotic stenosis: analysis of data collected prospectively from 1999 to 2004. Clin J Am Soc Nephrol. 2006;1:448-454.
• 7. Mickley V. Stenosis and thrombosis in haemodialysis fistulae and grafts: the surgeon’s point of view. Nephrol Dial Transplant. 2004;19:309-311.
• 8. Slinin Y, Greer N, Ishani A, et al. Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline. Am J Kidney Dis. 2015;66:823-836.
• 9. Tordoir J, Canaud B, Haage P, et al. EBPG on Vascular Access. Nephrol Dial Transplant. 2007;22(Suppl 2):ii88-ii117.
• 10. Ahmed S, Raman SP, Fishman EK. Three-dimensional MDCT angiography for the assessment of arteriovenous grafts and fistulas in hemodialysis access. Diagn Interv Imaging. 2016;97:297-306.
• 11. Vasanthamohan L, Gopee-Ramanan P, Athreya S. The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review. Cardiovasc Intervent Radiol. 2015;38:1179-1185. Fatih Gümüş. Akut AVF Trombozunda Cerrahi Trombektominin Yeri ve Sonuçları
• 12. Schmelter C, Raab U, Lazarus F, et al. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients. Cardiovasc Intervent Radiol. 2015;38:878-886.
• 13. Napoli M, Prudenzano R, Russo F, et al. Juxta-anastomotic stenosis of native arteriovenous fistulas: surgical treatment versus percutaneous transluminal angioplasty. J Vasc Access. 2010;11:346-351.
• 14. Napoli M, Montinaro A, Russo F, et al. Early experiences of intraoperative ultrasound guided angioplasty of the arterial stenosis during upper limb arteriovenous fistula creation. J Vasc Access. 2007;8:97-102.