Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
2885657 | Annals of Vascular Surgery | 2016 | 5 Pages |
Abstract
This report describes a simplified technique for management of aneurysmal arteriovenous fistulas along with results of initial clinical experience in 12 patients. Various techniques have been described which seek to repair the arteriovenous fistula and lengthen its duration of use. Here, we introduce the GIA-aneurysmorrhaphy and dermal detachment (GADD) procedure, a novel technique which requires minimal dissection to decompress tension on the overlying skin. Transverse incisions were made proximally and distally to the aneurysmal segment, which was then bluntly dissected along its length on either side. A GIA stapler is then fired along the longitudinal axis, narrowing the lumen of the fistula and separating the aneurysm from the skin. After the operation, the arteriovenous fistulae were used continuously until death (1 patient for 12Â months), until thrombosis (1 patient for 13Â months), or continue to be in use (9 patients, mean patency 18Â months). One patient underwent conversion to open aneurysmorrhaphy due to intraoperative fistula occlusion. Five patients resumed hemodialysis immediately, while the remaining resumed hemodialysis within 3Â months. The most common complication was cellulitis (3 patients). The GADD procedure as described in this report offers an effective and low-risk option for the management of venous aneurysms with threatened skin in hemodialysis patients.
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Authors
Jason Chang, Jateen Prema, Rose Pedersen, Yiping Li, Max Liebl, Kaushal Patel, Mark Mueller,