Creation of arteriovenous fistulas and grafts concomitantly with endovascular correction of outflow veins - a hybrid procedure.

Abstract

BACKGROUND\nAchieving well-functioning dialysis fistulas is a common problem in dialyzed patients, and it is mainly caused by the pathologies of vessels used for fistula creation. Hybrid therapies, combining surgical and endovascular procedures, potentially enable the creation of functional dialysis fistulas in patients with vessels that are otherwise unsuitable for vascular access.\n\n\nPATIENTS AND METHODS\nBetween 01.01.2014 and 30.06.2018, we created dialysis fistulas simultaneously with endovascular correction of outflow pathologies in 15 patients. The included patients had a long history of dialysis (median: 10.5 years, range: 3-22) and many previous dialysis access procedures (mean: 5.3 procedures, range: 2-9). In 13 patients (86.7%), the fistula was created on the upper arm; in five patients (33.3%), it was arteriovenous graft done with polytetrafluoroethylene (PTFE) prosthesis (in an additional 3 patients, a PTFE prosthesis was used to extend the vein), and seven patients had native vessel fistulas (46.7%). Endovascular procedures, in some cases performed on more than one vein, were applied for correction of the subclavian vein (eight patients, 53.3%); brachiocephalic vein (six patients, 40.0%); cephalic, basilic and axillary veins (two patients each, 13.3%); and superior cava vein (one patient, 6.7%). Access for the endovascular procedure was achieved through a dissected vein used for arteriovenous anastomosis. The fistula function was monitored, and all complications of dialysis access were noted. The median follow up in the observed group was 18 months. We compared patency of dialysis fistula creation combined with endovascular correction of outflow vein pathology to our results of standard dialysis fistula operations: radiocephalic dialysis fistula creation (RCAVF group, 65 patients), and dialysis fistula stenosis angioplasty (PTA group, 30 patients).\n\n\nRESULTS\nThe 12- and 24-month primary patency rates of dialysis fistulas created in hybrid procedures with simultaneous outflow vein pathology correction were 72.7 and 63.6%, respectively. No early complications related to endovascular or open procedures were observed.\n\n\nCONCLUSION\nA hybrid procedure for the creation of a dialysis fistula with the simultaneous correction of outflow pathologies enables a properly functioning dialysis fistula to be obtained. This procedure can be performed in patients with complicated vascular situations, enabling the creation of dialysis fistulas. Our results of hybrid procedures, involving simultaneous endovascular correction of the outflow vein with dialysis fistula creation, showed the efficiency and good results.