ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
SURGICAL TREATMENT OF ARTERIOVENOUS FISTULA COMPLICATIONS IN PATIENTS WITH CHRONIC RENAL FAILURE
Veysel Kutay, Hasan Ekim, Melike Karadağ, *Vechettin Öztürk, **Kaan Kırali, **Cevat Yakut
Van Yüksek İhtisas Hastanesi, Kalp Damar Cerrahi Kliniği, Van
*Van Yüksek İhtisas Hastanesi, Hemodiyaliz Kliniği, Van
**Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahi Kliniği, İstanbul
Background: There is no doubt that the first choice for the hemodialysis access is the autogenous arteriovenous fistula. The purpose of this study was to evaluate the incidence of arteriovenous fistula complication and results of surgical treatment in chronic renal failure patients.

Methods: From January 2000 to November 2003, 324 direct arteriovenous-fistula were performed on 251 patients suffering from end stage renal disease. Patient’s mean age was 49.4 ± 21.5 years and ranged from 13 to 74 years, 41% of them were female. The patients included in the study received 241 (74%) radiocephalic fistulas 114 (47%) were created in the anatomic snuff box, 127 (53%) in the forearm including wrist and 83 (26%) brachiocephalic-basilic fistulas.

Results: Occlusion of the access was the most common complication and occured in 62 cases. Six months primary patency rate was 76.3% for radiocephalic fistulas and 94% for brachiocephalic fistulas. The other complications which were seen after brachiocephalic fistulas are hematoma (13%), venous aneurysm (7%), arm edema (4.8%), pseudoaneurysm (2%) and hand ischemia (2%), respectively.

Conclusions: Although the early and late patency rates of brachiocephalic fistulas are higher than radiocephalic fistulas, the incidence of complication due to overflow of shunt is much more higher. The knowledge of the limitating factors and optimal conditions for suitable hemodialysis access and removing of the complications may improve the success of arteriovenous-fistulas.

Keywords : Arteriovenous fistulas, venous aneurysm, hemodialysis, chronic renal failure, pseudoaneurysm
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