Özet
Amaç. Kronik böbrek yetmezliği olan olgular hemodializ işlemi için düşük komplikasyon oranına sahip ve uzun süre açık kalabilen kalıcı arteriovenöz (AV) fistüllere ihtiyaç duyarlar. Bizim bu çalışmada amacımız AV operasyonları sonrası erken ve geç dönemde cerrahi revizyon gerektiren komplikasyonları belirlemektir. Yöntem. Çalışmaya toplam 1043 fistül operasyonunda revizyon gereken 322 olgu alındı. Van Yüksek İhtisas Hastanesinde 2003-2009 yılları arasında tek cerrah tarafından AV fistül operasyonu uygulanan erken dönem(ilk 48 saat) AV fistül komplikasyonu nedeniyle revizyon uygulanan (Grup 1) olgular ile geç dönem komplikasyon gelişen ve revizyon uygulanan (Grup 2) olgular çalışmaya dahil edildi. Bulgular. Grup1; 193 olgudan oluşuyordu. Olguların 120 sinde tromboz, 60 olguda kanama, 10 olguda hematom sebebi ile re-operasyonu uygulandı. Grup2; olguların ise toplam 132 olguya re-operasyonu uygulandı. Anevrizma nedeniyle 45 olguya, stenoz nedeniyle 32 olguya, tromboz nedeniyle 20 olguya, yüksek debi sebebiyle12 olguya, periferik iskemi ve steeling sebebiyle 13 olguya ve enfeksiyon kaynaklı kanama sebebiyle 10 olguya müdahale yapılmıştır. Sonuçlar. Kronik böbrek olgularında, fistül açıklığını artıracak stratejiler geliştirilmesi, AV fistülden diyalize giriş süresini uzatabilir. Erken dönem fistül trombozu yüksek olup bu da daha çok uygun damar seçimi, cerrahın tecrübesi, anastomoz tekniği, olguya kullanılan antiagregan ve anti koagülan kullanımı ile en aza inebileceğini düşünüyoruz.
Anahtar sözcükler: Arteriovenöz fistül, revizyon
Abstract
Aim. Arteriovenous (AV) fistula is a surgically created connection between artery and vein. Main characteristicses of an AV fistula are long term patency and low complication rate. This sudy aimed to assign the main problems, requiring surgical revision at the early and late stages of procedure. Methods. This study contains 322 patients, who had undergone surgical revision following 1043 AV fistula operation between 2003-2009. The operations were performed by only one surgeon. The patients were classified in two groups. First group is consisted of reintervention at the early stage (first 48 hours), and second group is consisted of reintervention at the late stage(term following48 hours). Results. Surgical reintervention was performed for thrombosis (n:120), bleeding (n:60) and hematoma (n:13) at the early stage to the first goup. At the late stage reintervention was performed to 132 patients totally. Pathologies causing a second intervention were aneurysm (n:45), stenosis (n:32), thrombosis (n:20), overflow (n:12) arterial steal and peripheric ischemia (n:13), bleeding related with infection (n:10). Conclusions. The strategies improving surgical success of AV fistula procedure would increase the vascular access patency, and this will potentially effect the morbidity and mortality of patients.The rate of short term fistula thrombosis would be minimalized with effective anastomosis techniques, surgical experience, antiaggregant and anticoagulant drug usage, and fistula formation between appropriate vascular structures.
Keywords: Arteriovenous fistula, reoperation
Background: Arteriovenous (AV) fistula is a surgically created connection between artery and vein. Main characteristicses of an AV fistula are long term patency and low complication rate. This sudy aimed to assign the main problems, requiring surgical revision at the early and late stages of procedure.
Method: This study contains 322 patients, who had undergone surgical revision following 1043 AV fistula operation between 2003-2009. The operations were performed by only one surgeon. The patients were classified in two groups. First group is consisted of reintervention at the early stage (first 24 hours), and second group is consisted of reintervention at the late stage(term following 24 hours).
Results: Surgical reintervention was performed for thrombosis (n:120), bleeding (n:60) and hematoma (n:13) at the early stage to the first goup. At the late stage reintervention was performed to 132 patients totally. Pathologies causing a second intervention were aneurysm (n:45), stenosis (n:32), thrombosis (n:20), overflow (n:12) arterial steal and peripheric ischemia (n:13), bleeding (n:10) and infection (n:13).
Conclusion: The strategies improving surgical success of AV fistula procedure would increase the vascular access patency, and this will potentially effect the morbidity and mortality of patients. The rate of short term fistula thrombosis would be minimalized with effective anastomosis techniques, surgical experience, antiaggregant and anticoagulant drug usage, and fistula formation between appropriate vascular structures.
Primary Language | English |
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Journal Section | Surgical Science Research Articles |
Authors | |
Publication Date | July 30, 2009 |
Published in Issue | Year 2009Volume: 31 Issue: 4 |