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《Journal of Third Military Medical University》 2018-06
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Clinical study of partial aneurysmectomy for salvage of aneurysmal dilatation of autogenous arteriovenous fistula

WAN Ziming;LAI Qiquan;CHEN Ling;GAN Hua;TU Bo;CHEN Liqun;Department of Nephrology,the First Affiliated Hospital of Chongqing Medical University;  
Objective To investigate the clinical effect of partial aneurysmectomy for salvage of autogenous arteriovenous fistula with aneurysmal dilatation. Methods A total of 39 patients with aneurysmal dilatation of autogenous arteriovenous fistula admitted in our department from July 2012 to June 2016 were included in this study. They were 27 males( 69. 2%) and 12 females( 30. 8%),and at a mean age of 40. 6 ± 13. 3 years. The aneurysmal dilatation of autogenous arteriovenous fistula that occurred in the anastomosis and pseudoaneurysms were excluded. All patients underwent color Doppler ultrasound examination to determine the brachial arterial blood flow,radial artery diameter,anastomotic diameter,fistula vein diameter, and maximum diameter of aneurysmal dilatation. All cases were treated with partial aneurysmectomy. The changes of the diameter of dilated blood vessels and flow of brachial artery were observed before and after the operation,and these changes were compared between the 2 groups by student's t test. The incidences of postoperative complications were observed during follow-up. Results All the patients had an upper arm arteriovenous fistula,including 12 cases of radiocephalic fistula( radial artery to cephalic vein),25 cases of brachiocephalic fistula( radial artery to cephalic vein) and 2 cases of elbow fistula( brachial artery to cephalic vein). There were only 15 cases of 1 tumor body,19 cases of 2 tumor bodies,4 cases of 3 tumor bodies and 1 case of 4 tumor bodies. The arteriovenous fistulas were for a mean duration of 41. 05 ± 14. 45 months. The operation was succeeded in all cases. During the mean follow-up period of 27. 73 ± 8. 59 months,the diameter of the dilated section was reduced by 76. 27%,from 43. 79 ± 4. 74 mm preoperatively to 10. 39 ± 1. 82 mm postoperatively( t = 41. 08,P 0. 01). Blood flow of the brachial artery was also decreased by 53. 22%( from 1 647. 39 ± 250. 33 to 770. 59 ± 130. 10 mL/min,t = 19. 41,P 0. 01). Two patients died during follow-up,one due to severe cerebral hemorrhage and the other to acute myocardial infarction. Fistula stenosis was found in 7 patients,and the condition was relieved after balloon expansion under the guidance of color Doppler ultrasound. Conclusion Partial aneurysmectomy can retain the function of autogenous arteriovenous fistula and length of the puncture,and extend the service life of arteriovenous fistula with distinct clinical effect in the treatment of aneurysmal dilatation of autogenous arteriovenous fistula.
【CateGory Index】: R654.3
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