A modified stapling technique for the repair of an aneurysmal autogenous arteriovenous fistula.

Matteo Tozzi, Marco Franchin, Giuseppe Ietto, Gabriele Soldini, Corrado Chiappa, Giulio Carcano, Patrizio Castelli, Gabriele Piffaretti

Index: J. Vasc. Surg. 60(4) , 1019-23, (2014)

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Abstract

An alternative surgical technique for the repair an aneurysmatic arteriovenous fistula (AVF) using a staple remodeling operation has been developed and the results are reported.All patients presenting with an aneurysmatic autogenous AVF of the upper extremities between January 2012 and December 2013 were included in the analysis. The AVF was approached laterally along the entire aneurysm and then remodeled using a stapler on the lateral side of the vein wall. All stenotic segments were excised. Follow-up included a clinical visit and echo color Doppler of the fistula and was performed 7, 15, and 30 days after the intervention and every 6 months thereafter.We treated 14 patients (nine men [64.3%]) with a median age of 65 years (interquartile range [IQR], 62.5-69 years). Elective interventions were performed in 12 patients (85.7%), and two underwent emergency treatment because of postcannulation bleeding. Technical success was achieved in all cases. The mean duration of the intervention was 75 minutes (IQR, 61.15-83.45 minutes). No in-hospital deaths or major morbidities were observed. Median hospitalization time was 24 hours (IQR, 25-38 hours). Postoperative puncture was performed after a median delay of 12.5 hours (IQR, 12-17 hours). No patient was lost during the follow-up, which was a median of 16.5 months (IQR, 14-23 months). Primary functional patency was 12 of 14 (85.7%). Pseudoaneurysm, bleeding, hematoma, or infection was not observed.In our experience, the stapling technique proved to be easy, fast, and safe. Early follow-up outcomes showed excellent primary patency and confirmed the effectiveness of the technique because local complications were never observed.Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.