Vascular complications for hemodyalisis. Role of microsurgery

This artiche describes the treatment of 66 early and late vascular complications of native arteriovenous fistola (AVF) in patients with end-stage renal disease, between January 1987 and January 2005. Thirty were arteriovenous aneurisms and three pseudoaneyrysms; thirty were tromboses. We also observed two cases of periarteritis associated with sistemic lupus erithematosus (SLE) and one complex iatrogenic lesion caused by an attempt at percutaneos restoration of potency. We applied microsurgical principles, instruments, and techniques. It was possible to restore a vascular access at the original site, using the same vessels in 55 cases (83.3%). In 10.9% of cases, we were able to rescue the original AVF by microsurgical revision. A new vascular access had to be created proximally in the same limb ar in the controlateral forearm in 12 cases (18% of the total, 40% of the aneurysms). After a minimum follow-up of 8 months, the 7.6% of the patients had to be reoperated for further complications. Our data support the idea that microsurgical treatment of vascular complications of native AVF is highly successful compared with results obtained by conventional surgery and, in a defined subgroup of patients, permits salvage of the fistula.