Operative Treatment of Septic Hemorrhage Due to Dialysis Arterio-Venous Fistula
The number of hemodialyzed patients in western countries is growing consistently. Septic complications of vascular access obtained with artificial prostheses are a significant therapeutic problem. Septic bleeding from infected arterio-venous fistula is a life-threatening condition.The aim of the study was to evaluate the results of treatment for septic bleeding from arterio-venous fistula. Data was gathered at the General, Vascular Department at Central Clinical Hospital Ministry of Internal Affairs.Material and methods. Between January 12004 and December 31, 2008, we noticed septic bleeding caused by infectious complications of dialysis fistula in 6 of 348 patients who underwent operation for arterio-venous fistula.Results. All of the patients with septic bleeding had arm fistula due to the employment of vascular prostheses. Successful dialysis fistula reconstruction was performed in 5 of 6 patients. Reconstruction of the brachial artery was carried out in the sixth patient. In all cases, we used segments of autogenous saphenous vein as reconstructive material. Patients with septic bleeding were significantly more likely to have undergone a vascular access operation or fistula reconstruction, in comparison to the group of non-septic patients.Conclusions. The highest risk of septic bleeding as a result of dialysis fistula infection is observed in patients with fistulas preformed with vascular prosthetic grafts. Patients operated due to septic bleeding have the possibility to maintain existing vascular access for dialysis. Our results indicate that the best material for infected dialysis fistula reconstruction is autogenous saphenous vein.
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