Other mechanical complication of surgically created arteriovenous fistula Save

Other Mechanical Complications of Surgically Created Arteriovenous Fistula

Surgically created arteriovenous fistula (AVF) is a common intervention for patients with chronic kidney disease who require hemodialysis. This procedure involves connecting an artery and vein, usually in the arm, to create a larger and more durable vessel for dialysis access. Although AVF is generally safe and effective, there are some mechanical complications that may arise, which can affect the function and longevity of the access.

1. Stenosis

Stenosis, or narrowing of the AVF, is a common mechanical complication that can occur at various locations along the access. It is often caused by intimal hyperplasia, which is the thickening of the inner layer of the blood vessel. Stenosis can reduce blood flow through the access, leading to poor dialysis clearance and increased risk of thrombosis. Treatment options include angioplasty, stenting, and surgical revision.

2. Thrombosis

Thrombosis, or blood clotting, is another mechanical complication that can occur in AVF. It can be caused by various factors, including stenosis, infection, and inadequate anticoagulation. Thrombosis can lead to access dysfunction and failure, requiring interventions such as thrombectomy, thrombolysis, or surgical revision. To prevent thrombosis, patients should receive adequate anticoagulation and monitoring.

3. Aneurysm

Aneurysm, or dilation of the AVF, is a less common mechanical complication that can occur in AVF. It is often caused by high blood flow and pressure within the access, which can weaken the vessel walls. Aneurysm can lead to access rupture, bleeding, or fistula steal syndrome, which is the diversion of blood flow away from the distal extremity. Treatment options include surgical revision or ligation.

4. Pseudoaneurysm

Pseudoaneurysm, or false aneurysm, is a rare mechanical complication that can occur in AVF. It is usually caused by trauma or repeated needle puncture, which can create a hole in the vessel wall and a pocket of blood outside the vessel. Pseudoaneurysm can lead to access rupture, bleeding, or infection. Treatment options include ultrasound-guided compression, thrombin injection, or surgical revision.

In conclusion, surgically created AVF is a valuable intervention for patients with chronic kidney disease who require hemodialysis. However, mechanical complications can occur and affect the function and longevity of the access. Therefore, patients