Tratamiento quirúrgico de las estenosis yuxtaanastomóticas en las fístulas arteriovenosas radiocefálicas de hemodiálisis. Nueva anastomosis proximal

Abstract

Introduction: The yuxtaanastomotic stenosis is the most frequent cause of dysfunction in radiocephalic fistulas for haemodialysis. This adversity can cause low flow or thrombosis. The treatment of these lesions is under debate. Method: A prospective study was performed from 1998 to 2009. Alldysfunctional radiocephalic fistulas due to yuxtaanastomotic stenosis were included (n=96). The diagnosis was made by fistulografy in low flow cases and clinical evidence in cases of thrombosis. The repair was performed using a new proximal radiocephalic anastomosis in all cases. Patency following surgical intervention was estimated with the Kaplan-Meier method. Results: A total of 96 proximal radiocephalic anastomosis were performed during the study period. Mean surveillance time was 57.27 months (95% CI: 47.53-67.02). Sixty six patients were male and the mean age was 67 years. Scheduled surgery was performed in 70.5% of cases and 29.5% were emergency procedures, 92% of which were ambulatory. Technical success was achieved in 100% without any complications. Primary patency at 1, 2, 3, 4, and 5 years was 89.4%, 75%, 70.4%, 65%, and 56%, respectively. Additional procedures (n=16) were required in 14 cases (twelve new proximal anastomosis and four cases of arteriovenous graft placement), resulting in secondary patency at 1, 2, 3, 4, and 5 years of 93.7%, 92.1%, 89.6%, 87%, and 82.6%, respectively. Secondary patency of initial dysfunctional radiocephalic fistulas at 1, 2, 3, 4, and 5 years was 95%, 95%, 93.2%, 89.1%, and 86.6%, respectively. Conclusions: In our experience the proximal radiocephalic anastomosis can significantly extend fistula functionality in patients with juxtaanastomotic stenosis. © 2012 Revista Nefrología.