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Operative Treatment of Septic Hemorrhage Due to Dialysis Arterio-Venous Fistula

100%
Bojakowski K., Andziak P.
Polish Journal of Surgery
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2010
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vol. 82
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issue 3
123-129
EN
The number of hemodialyzed patients in western countries is growing consistently. Septic complications of vascular access obtained with artificial prostheses are a significant therapeutic problem. Septic bleeding from infected arterio-venous fistula is a life-threatening condition.The aim of the study was to evaluate the results of treatment for septic bleeding from arterio-venous fistula. Data was gathered at the General, Vascular Department at Central Clinical Hospital Ministry of Internal Affairs.Material and methods. Between January 12004 and December 31, 2008, we noticed septic bleeding caused by infectious complications of dialysis fistula in 6 of 348 patients who underwent operation for arterio-venous fistula.Results. All of the patients with septic bleeding had arm fistula due to the employment of vascular prostheses. Successful dialysis fistula reconstruction was performed in 5 of 6 patients. Reconstruction of the brachial artery was carried out in the sixth patient. In all cases, we used segments of autogenous saphenous vein as reconstructive material. Patients with septic bleeding were significantly more likely to have undergone a vascular access operation or fistula reconstruction, in comparison to the group of non-septic patients.Conclusions. The highest risk of septic bleeding as a result of dialysis fistula infection is observed in patients with fistulas preformed with vascular prosthetic grafts. Patients operated due to septic bleeding have the possibility to maintain existing vascular access for dialysis. Our results indicate that the best material for infected dialysis fistula reconstruction is autogenous saphenous vein.
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Upper limb ischaemia after formation of dialysis fistula

81%
Bojakowski K., Góra R., Jodkowski G., Andziak P.
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vol. 85
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issue 11
649-656
EN
Limb ischaemia caused by formation of dialysis fistula is rare but serious complication. The severity of symptoms may vary but rest pains and necrotic lesions are observed in most advance cases. In these patients different invasive procedures for treatment are performed - from simplest dialysis fistula ligation to complicated vascular reconstructions. The aim of the study was to evaluate treatment results of upper limb ischaemia triggered by dialysis fistula. Material and methods. We have analysed methods and results of treatment of 14 patients with symptomatic upper limb ischaemia caused by dialysis fistula treated in our department between 1st January, 2006 and 30th June, 2013. Treatment was subject to anatomical situation and clinical symptoms. In three patients the ligation of dialysis fistula was performed, four patients underwent inflow reconstruction - in one case by ligation of ligation of vein branch, in three patients by cephalic transfer of arterial anastomosis. In 2 patients hyperkinetic fistula aneurysm was excised and replaced by PTFE bypass, in three patients fistula reconstruction with DRIL method (distal revascularization - interval ligation) was performed, in one patient surgical operation of brachial artery stenosis was conducted. One patient underwent brachial artery angioplasty. Results. Rest pains occurred in all patients (100%), regressive changes in 10 patients (71.4%). Eight patients (57.2%) had concomitant diabetes, seven (50%) ischaemic heart disease, five (35.5%) chronic lower limb ischemia and hyperparathyroidism was observed in fivepatients (35.5%). The imaging studies in all patients revealed pathological steal syndrome (stealing blood to the fistula), in majority concurrent with other pathologies - obstruction stenosis of peripheral artery, defects in blood out flow from the limb. As a result of the surgical treatment, symptoms of limb ischaemia subsided in all patients. Conclusions. Critical limb ischaemia caused by dialysis fistula is a dangerous complication. In most cases there are several causes of ischaemia. Treatment methods should be selected individually for each patient and clinical situation. Clinical symptoms should subside as a result of optimal choice of treatment and, if possible, maintaining of dialysis access.
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Blood Platelet Accumulation in a Dacron Graft Implanted in a Patient with Abdominal Aorta Aneurysm: Quantitative Scintigraphic Assessment Using Indium-111 Labeled Platelets - Case Report*

71%
Jeleńska M., Bojakowski K., Mączewska J., Królicki L., Szmidt J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 9
610-613
EN
During routine screening after abdominal aorta aneurysm repair, thrombocytopenia accompanied by chronic activation of coagulation was detected in an 80-year old patient. Coagulation activity was assessed by the increased concentration of coagulation and fibrinolysis activation markers (prothrombin fragment F1+2 and D-dimer). After the most common causes of such activation were excluded using imaging and laboratory studies, Indium-111 labeled autologous blood platelet accumulation on a dacron graft was demonstrated using the scintigraphic technique. Thus, the implanted dacron graft was the cause of chronic thrombocytopenia and coagulation activation during the two years of follow up.
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