Vascular complications of native arteriovenous fistulas for hemodialysis: Role of microsurgery

This article describes the treatment of 56 early and late vascular complica tions of native arteriovenous fistula (AVF) in patients with end-stage rena l disease, between January 1987 and January 1999. Twenty-six were arteriove nous aneurysms and 2 pseudoaneurysms; 25 were thromboses. We also observed two cases of periarteritis associated with systemic lupus erythematosus (SL E) and one complex iatrogenic lesion caused by an attempt at percutaneous r estoration of potency. We applied microsurgical principles, instruments, an d techniques. It was possible to restore a vascular access at the original site, using the same vessels in 45 cases (80.4%). In 10.7% of cases, we wer e able to rescue the original AVF by microsurgical revision. A new vascular access had to be created proximally in the same limb or in the contralater al forearm in 11 cases of aneurysms (19.6% of the total, 42% of the aneurys ms). After a minimum follow-up of 8 months, a total of four patients had to be reoperated far further complications (7.2%). Our data support the idea that microsurgical treatment of vascular complications of native AVF is hig hly successful compared with results obtained by conventional surgery and, in a defined subgroup of patients, permits salvage of the fistula.