Safety Issues in Surgical and Endovascular Techniques to Rescue Failing or Failed Arteriovenous Fistulas and Arteriovenous Grafts

Abstract

A great variety of thrombotic and nonthrombotic events may complicate all types of vascular access (VA) procedures. Thrombotic events are the most frequent complication, caused by stenoses in various locations, representing a common problem for arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Monitoring AVF with physical examination by trained physicians represents an accurate method for diagnosis of malfunction. AVF stenoses >50% in diameter should be treated either by surgical or endovascular means when accompanied with access malfunction. Aneurysms and infections represent the most frequent nonthrombotic VA complications. Access-related aneurysms do not represent per se an indication for intervention; however, anastomotic aneurysms and those with skin erosion should be repaired urgently to avoid rupture. Infections of AVFs are extremely rare, while AVG could be complicated either with postoperative infections attributable to the initial procedure with an early onset and more frequently with late infections caused by punctures, with an annual rate of 5%. Treatment options for AVG infections comprise total or subtotal graft excision or partial excision of the involved segment only, the latter representing a VA salvage procedure but with a significantly higher risk of recurrence.

Comparison of standard forearm prosthetic loop grafts to composite semiloop forearm grafts (“semi‐grafts”) in hemodialysis patients: A prospective study

“…In general, on‐table angiography (fistulography) was performed after Fogarty catheter thrombectomy, visualizing the arterial inflow, the graft and the vein outflow vessel. Treatable lesions were managed with percutaneous transluminal angioplasty/stenting or self‐expanding stent‐grafts, while stenosed segments were approached surgically if endovascular therapy failed or if open repair techniques were considered more relevant . Other complications (infection, false aneurysms) were revised accordingly .…”

“…Treatable lesions were managed with percutaneous transluminal angioplasty/stenting 8 or self-expanding stent-grafts, while stenosed segments were approached surgically if endovascular therapy failed or if open repair techniques were considered more relevant. [18][19][20] Other complications (infection, false aneurysms) were revised accordingly. [20][21][22][23] Unsalvageable shunts were abandoned for the creation of a new autogenous or prosthetic one.…”

Use of a temporary shunt to preserve the patency of a hemodialysis graft while performing ipsilateral axillo-femoral bypass

“…Furthermore, safety issues in surgical and endovascular techniques to rescue failing or failed arteriovenous fistulas and arteriovenous grafts are also imortant. 2 Although vascular access dysfunction is considered a major health and economic burden, there are several challenges to optimizing vascular access outcomes or understanding the pathophysiology of access thrombosis. 3,4 On the other hand, axillo-femoral bypass has been traditionally used as an alternative approach in high-risk patients with aorto-iliac occlusive disease, in abdominal graft infections and in patients with "hostile" abdomen.…”

Preemptive Open Surgical vs. Endovascular Repair for Juxta-Anastomotic Stenoses of Autogenous AV Fistulae: A Meta-Analysis

“…These stenoses have been classified on the basis of their location as juxta-anastomotic (Type I), in the cannulable segment (Type II), and at the outflow junction into the deep venous system (Type III) (2). Two additional types of stenoses not involving the access itself, those of the central veins, and those of the arterial inflow have also been described and the method for repair for all five types depends on the location of the lesion (3). The best strategy of whether to use surgical or endovascular means for treating the various lesions remains obscure (4).…”