Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2019 Vol. 27 No 5

GENERAL & SPECIAL SURGERY

A.N. POPOV1, B.A. VESELOV 2, E.P. BURLEVA 3

DISTAL ARTERIOVENOUS FISTULAS IN PATIENTS WITH TERMINAL CHRONIC RENAL FAILURE

Municipal Clinical Hospital ¹ 40 1,
Clinical Hospital at the Station Yekaterinburg-Passazhirsky, Russian Railways 2,
Ural State Medical University 3, Yekaterinburg
The Russian Federation

Objective. To carry out comparative analysis of the complications structure and the four-year survival of two types of radial-cephalic arterial-venous fistula – in the “anatomical snuffbox” and the Brescia-Cimino type.
Methods. 323 patients with the terminal chronic failure were analyzed, with 358 radial – cephalic fistulas applied. Group I included 53 patients with a radial – cephalic fistula in an “anatomical snuffbox” (n=53). Group II was made up of 270 patients with a radial – cephalic fistula of the Brescia-Cimino type (n=305). Complications and primary cumulative patency of the fistulas were evaluated in both groups in terms of 12 and 48 months.
Results. 9 thrombotic complications were revealed in the group I. 4 reconstructive operations were performed; 5 accesses were lost without surgery.
136 complications were revealed in the group II. There were 123 cases of thrombotic complications; a true aneurysm was in 3 cases, the failure of fistula in connection with the failure of volumetric blood flow rate – in 4, stenosis in the anastomosis – in 6. 48 operations were performed in thrombosis: 26 reconstructive and restorative 22 ones. In aneurysms, their resection was performed; in case of inadequate volume blood flow, 4 operations were performed to ligation the tributaries, in 6 – reconstruction of the fistula with the formation of a new anastomosis. In connection were lost 87 of 305 of vascular accesses with the thrombosis.
Cumulative patency after 12 and 48 months in group I was 90.33% and 52.12%, in group II 76.95% and 46.69% (p<0.05).
Conclusions. Radial-cephalic fistula, formed in the «anatomical snuffbox», has fewer complications and a higher four-year cumulative patency compared to the type of fistula Brescia-Cimino. The availability of the cephalic vein and the radial artery to assess their suitability before the formation of the fistula during clinical examination and the technical simplicity of applying the radial-cephalic fistula in the “anatomical snuffbox” allows considering this vascular access as a priority among the distal fistulas.

Keywords: arteriovenous fistula, anatomical snuffbox, Brescia-Cimino fistula, cumulative patency, complications
p. 496-504 of the original issue
References
  1. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966 Nov 17;275(20):1089-92. doi: 10.1056/NEJM196611172752002
  2. Rassat JP, Moskovtchenko, Perrin J, Traeger J. Artero-venous fistula in the anatomical snuff-box. J Urol Nephrol (Paris). 1969 Dec;75(12):Suppl 12:482. https://europepmc.org/abstract/med/5386922 [Article in French]
  3. Raza MW, Waqas K, Ayub M, Hanif M, Khan MM. Anatomical snuff box arteriovenous fistulas for haemodialysis. J Rawalpindi Med College (JRMC). 2014;18(1):80-82. https://journalrmc.com/volumes/1405750166.pdf
  4. Simoni G, Bonalumi U, Civalleri D, Decian F, Bartoli FG. End-to-end arteriovenous fistula for chronic haemodialysis: 11 years’ experience. Cardiovasc Surg. 1994 Feb;2(1):63-66. doi: 10.1177/096721099400200114
  5. Wolowczyk L, Williams AJ, Donovan KL, Gibbons CP. The snuffbox arteriovenous fistula for vascular access. Eur J Vasc Endovasc Surg. 2000 Jan;19(1):70-76. doi: 10.1053/ejvs.1999.0969
  6. Scher LA, Shariff S. Strategies for Hemodialysis Access: A Vascular Surgeon’s Perspective. Tech Vasc Interv Radiol. 2017 Mar;20(1):14-19. doi: 10.1053/j.tvir.2016.11.002
  7. Kirnap M, Tezcaner T, Moray G. Secondary vascular access procedures for hemodialysis after primary snuff-box arteriovenous fistula. J Clin Anal Med. 2017;8(3):190-94. doi: 10.4328/JCAM.4799
  8. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G,Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JHM, van Loon M, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R,Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, Esvs Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757-18. doi: 10.1016/j.ejvs.2018.02.001
  9. Letachowicz K, Gołębiowski T, Kusztal M, Letachowicz W, Weyde W, Klinger M. The snuffbox fistula should be preferred over the wrist arteriovenous fistula. J Vasc Surg. 2016 Feb;63(2):436-40. doi: 10.1016/j.jvs.2015.08.104
  10. Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg. 2004 Dec;28(6):583-89. doi: 10.1016/j.ejvs.2004.08.014
  11. Hendrik B. Vascular access for haemodialysis: long term results, costs and the effects of percutaneous transluminal angioplasty. Proefschrift Maastricht: Met lit. opg; 1994. 108 ð. https://cris.maastrichtuniversity.nl/ws/files/1537937/guid-8382d302-d9cf-4f1c-8fac-5933a7bbbfb4-ASSET1.0
  12. Gibbons CP. Primary vascular access. Eur J Vasc Endovasc Surg. 2006 May;31(5):523-29. doi: 10.1016/j.ejvs.2005.10.006
  13. Moisiuk IaG, Beliaev AIu. Postoiannyi sosudistyi dostup dlia gemodializa. Tver’, RF: Triada; 2004. 152 p. (in Russ.)
  14. Twine CP, Haidermota M, Woolgar JD, Gibbons CP, Davies CG. A scoring system (DISTAL) for predicting failure of snuffbox arteriovenous fistulas. Eur J Vasc Endovasc Surg. 2012 Jul;44(1):88-91. doi: 10.1016/j.ejvs.2012.03.014
Address for correspondence:
620102, The Russian Federation,
Yekaterinburg, Volgogradskaya Str., 189,
Municipal Clinical Hospital ¹ 40,
Vascular Surgery Unit.
Tel.: 8 912 600 300 8,
e-mail: burleva@gkb40.ur.ru,
e.p.burleva@gmail.com,
Elena P. Burleva
Information about the authors:
Popov Alexey N., PhD, Vascular Surgeon of the Vascular Surgery Unit, Municipal Clinical Hospital ¹ 40, Yekaterinburg, Russian Federation.
http://orcid.org/0000-0002-7213-4505
Veselov Boris A., PhD, Vascular Surgeon of the Vascular Surgery Unit, Clinical Hospital at the Station Yekaterinburg-Passazhirsky, Russian Railways, Yekaterinburg, Russian Federation.
http://orcid.org/0000-0002-4350-5282
Burleva Elena P., MD, Professor of the Department of Surgery, Endoscopy and Coloproctology, Ural State Medical University, Yekaterinburg, Russian Federation.
http://orcid.org/0000-0003-1817-9937
Contacts | ©Vitebsk State Medical University, 2007-2023