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Content available remote 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.
Native arteriovenous fistula is considered the best type of access for dialysis. Its function is affected by multiple factors.The aim of the study was to identify risk factors of the loss of fistula patency.Material and methods. Between 1990-2004, 218 patients underwent 276 surgical procedures involving vascular access creation. In 245 (89%) of cases, a fistula was created using only patient's own blood vessels; in 31 (11%) of cases a vascular graft was implanted. 158 (64%) radio-cephalic fistulae were created, 15 (6%) radiobasilic fistulae, 33 (14%) brachiocephalic and 39 (16%) brachiobasilic fistulae. Duration of primary patency was identified for 217 native fistulae. Age, gender, diabetes mellitus, type, mode of creation and fistula location, vein translocation, type of anastomosis and time of initial cannulation were analyzed as potential factors affecting the fistula patency. Cox proportional hazards model was used in the analysis.Results. Probability of fistula patency loss in patients above 46 years of age was 2.12-fold higher than in younger patients and 1.62-fold higher for end-to-side anastomosis versus end-to-end anastomosis. Risk of loss of patency in fistulae cannulated for the first time within the first 14 days, 15-21 days and 22-35 days from their creation was 31-, 19- and 7-fold higher than when they were cannulated after the first 35 days.Conclusions. Type of vascular anastomosis, age above 46 years and time of the first cannulation are independent risk factors of the loss of patency of vascular access. First cannulation should not take place earlier than 7 weeks after its creation.
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