Rodriguez S, Pomy BJ, Mangipudi S, Sidawy AN, Ricotta JJ, Nguyen BN, Lala S, Macsata R. Single-Institution Learning Curve for Management of Mega-Fistulae Revision.
Ann Vasc Surg 2021;
80:130-135. [PMID:
34748944 DOI:
10.1016/j.avsg.2021.08.047]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/01/2022]
Abstract
Mega-fistulae are generalized aneurysmal dilations of a high flow (1500-4000 mL/min) autogenous arteriovenous (AV) access which may result in hemorrhage and/or high-output cardiac failure. Current treatment options for mega-fistula include ligation with and without prosthetic jump graft, aneurysmorrhaphy, aneurysmectomy with vein transposition, and imbrication. These options may not be suitable for advanced disease; may leave the patient without working AV access, poor cosmetic results, and possible recurrence. We describe our early experience with a technique of complete mega-fistula resection and replacement with an early use prosthetic graft that both maintains existing AV access and eliminates the need for long-term catheter placement; including lessons learned.
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