Outcomes of operative intervention for ulcers over hemodialysis arteriovenous access

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-02-09 DOI:10.1111/hdi.13075

Thilina Gunawardena, Hemant Sharma, Sanjay Mehra

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引用次数: 0

Abstract

Introduction

The native arteriovenous fistula (AVF) is the gold standard for long-term hemodialysis access. When native vein options are exhausted, arteriovenous graft (AVG) becomes the next choice. An ulcer over an AVF or AVG is a serious condition with the potential for life-threatening hemorrhage.

Objectives

This study aims to present our experience with surgical management of ulcers over AVFs or AVGs.

Materials and Methods

Electronic records of 26 patients who underwent 27 consecutive surgical procedures for ulcers over AVFs or AVGs from December 31, 2016 to December 31, 2021 at the Royal Liverpool University Hospital were retrospectively analyzed.

Results

The majority were males (14/26, 53.8%) and the median age was 64.5 years. Operative repair was required for 25 ulcers over 24 AVFs and 2 ulcers over 2 AVGs. Ten patients (37%) presented with bleeding. Seventeen (63%) had impending bleeding suggested by a thin soft tissue covering or a false aneurysm at the site of the ulcer. Previous endovascular intervention for fistula outflow stenosis was a significant predictor for presenting with bleeding (p = 0.031). All ulcers (27/27, 100%) underwent excision and primary skin closure. Fistula wall defects were directly repaired in 18/27 (66.7%). Four/26 (14.8%) fistulas had to be ligated and 2 (7.4%) had end-to-end re-anastomosis after excision of damaged segments. Three/26 (11.53%) fistulas thrombosed immediately after the intervention. The overall fistula salvage rate was 73.08% (19/26). There was 1 (3.7%) patient mortality due to bleeding from wound breakdown after surgery.

Conclusions

An acceptable fistula salvage rate can be expected following surgical repair of ulcers over AVFs and AVGs. A history of previous endovascular interventions for fistula outflow stenosis was a predictor of bleeding from these ulcers.

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血液透析动静脉通道溃疡的手术干预效果

原生动静脉瘘(AVF)是长期血液透析通路的金标准。当原生静脉选择用尽时，动静脉移植物(AVG)成为下一个选择。AVF或AVG以上的溃疡是一种严重的疾病，有可能导致危及生命的出血。目的:本研究旨在介绍外科治疗avf或avg溃疡的经验。材料与方法回顾性分析2016年12月31日至2021年12月31日在皇家利物浦大学医院连续27次手术治疗avf或avg溃疡的26例患者的电子记录。结果男性居多(14/26,53.8%)，中位年龄64.5岁。24个avf以上25个溃疡，2个avg以上2个溃疡需要手术修复。10例患者(37%)出现出血。17例(63%)患者在溃疡部位有薄的软组织覆盖或假性动脉瘤提示即将出血。先前对瘘口流出狭窄进行血管内介入治疗是出现出血的重要预测因子(p = 0.031)。所有溃疡(27/27,100%)均行切除和原发性皮肤闭合。瘘壁缺损直接修复18/27(66.7%)。4 /26例(14.8%)需要结扎，2例(7.4%)在切除受损节段后需要端到端再吻合。3 /26(11.53%)的瘘管在干预后立即形成血栓。总瘘管保留率为73.08%(19/26)。1例(3.7%)患者术后因伤口破裂出血死亡。结论在avf和avg的溃疡手术修复后，可获得可接受的瘘管保留率。既往血管内介入治疗瘘口流出狭窄的历史是这些溃疡出血的预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.