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XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.
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 № 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.
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620102, The Russian Federation,
Yekaterinburg, Volgogradskaya Str., 189,
Municipal Clinical Hospital № 40,
Vascular Surgery Unit.
Tel.: 8 912 600 300 8,
Elena P. Burleva
Popov Alexey N., PhD, Vascular Surgeon of the Vascular Surgery Unit, Municipal Clinical Hospital № 40, Yekaterinburg, Russian Federation.
Veselov Boris A., PhD, Vascular Surgeon of the Vascular Surgery Unit, Clinical Hospital at the Station Yekaterinburg-Passazhirsky, Russian Railways, Yekaterinburg, Russian Federation.
Burleva Elena P., MD, Professor of the Department of Surgery, Endoscopy and Coloproctology, Ural State Medical University, Yekaterinburg, Russian Federation.