Surgical salvage of ruptured arteriovenous fistula for hemodialysis with bleeding

Abstract EN

Background / Aim : the ruptured arteriovenous fistula (AVF) with bleeding is an emergency Situation in end stage renal disease (ESRD) patient who is already anemic patient with co-morbid conditions.

Infection, pseudo- aneurysm and complete disruption of anastomotic suture line may be found in these cases.

There is no report regarding the surgical salvage of the failed ruptured native AVF with bleeding and the current literature is only about ligation of the AVF.

The aim of the work is to report the safety and efficacy of surgical management of bleeding ruptured AVFs by arrest of bleeding and reconstruction of a new one using the same artery and already mature vein at the same situation to maintain the valuable vascular access.

Materials and methods : this retrospective study involved 16 patients (9 males, 7 females) with mean age 48.5 years with ESRD who presented as emergency bleeding ruptured AVFs during three years' time period.

In 15 cases there were complete disruption of the of the anastomotic suture line (12 brachiocephalic, 3 radio-cephalic), and in the middle of one saphenous loop in the thigh.

Recreation of the AVFs was done by end to end anastomosis of the proximal part of the healthy artery and mature vein fashioned as smooth U figure in proximal healthy tissues.

Results : diabetes mellitus was the cause of ESRD in 12, systemic lupus erythomatouses (SLE) in 2 and chronic glomerulonephritis in 2 cases.

Mean tourniquet time was 13 minutes .No intra-operative blood transfusion was needed.

Mean digital Oxygen saturation was 92 %.

Mean operative time was 50 minutes.

Mean duration of hospital admission was 2 days.

Post-operative broad spectrum antibiotics were given and after that according to the culture and sensitivity.

One patient had nerve concussion due to tourniquet, one patient had secondary hemorrhage after one week and the fistula was ligated and another patient had short fistula in the arm.

Mean time of postoperative use of salvaged AVFs in HD (hemodialysis) was one week .No mortality due to the procedure or during the time of the study was recorded.

Fourteen AVFs in mean period of follow-up was 18 months (range 3 to 36 months) are functioning.

Conclusion : surgical salvage of the ruptured arterial -venous fistula (AVF) with bleeding even with presence of infection is an effective procedure that achieves many goals : saving the life of the patient, continued primary and secondary patency of the native fistula, avoidance of limb ischemia, avoidance of temporary catheters and their complications, avoidance of creation of new AVF in another site with exhaustion the available veins and waiting for their maturation so, i decreasing mortality and morbidity of the patients.