Surgical treatment of juxta-anastomotic stenosis in radiocephalic fistula. A new proximal radiocephalic anastomosis.
BACKGROUND
The juxta-anastomotic stenosis is the most frequent cause of dysfunction in radiocephalic fistulas for haemodialysis. This adversity can cause low flow or thrombosis. The appropriate treatment of these lesions is under debate.


METHODS
A prospective study was performed from 1998 to 2009. All dysfunctional radiocephalic fistulas due to juxta-anastomotic 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 anastomoses 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. Mean 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 anastomoses and four cases of arteriovenous graft placement), resulting in mean secondary patency at 1, 2, 3, 4, and 5 years of 93.7%, 92.1%, 89.6%, 87%, and 82.6%, respectively. Mean 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 juxta-anastomotic stenosis.
Servicio de Cirugía General, Hospital Universitario Fundación Alcorcón, Poza de la Sal, 28031 Alcorcón, Madrid, Spain. pjimenez@fhalcorcon.es
Pedro
P
Jiménez-Almonacid
Enrique
E
Gruss-Vergara
Marta
M
Jiménez-Toscano
Manuel
M
Lasala
José A
JA
Rueda
José
J
Portolés
Ana
A
Tato
Laura
L
Vega
Paula
P
López-Sánchez
M Isabel
MI
Mas
Antonio
A
Quintans
D000368:Aged; D000556:Ambulatory Surgical Procedures; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001783:Blood Flow Velocity; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic; D004630:Emergencies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D006435:Renal Dialysis; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D014654:Vascular Patency