초록접수 현황
| 17F-024 | 포스터 발표 |
Staple Aneurysmorrhaphy to Salvage Arteriovenous Fistula with Aneurysm
Up Huh, Chung Won Lee, Sang-pil Kim, Seunghwan Song, Miju Bae, Sung Woon Chung
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Republic of Korea
Purpose : Aneurysm-related complications could lead to loss of a functioning arteriovenous fistula (AVF). We report the staple aneurysmorrhaphy technique to repair and preserve aneurysmal AVFs.
Methods : The patient underwent right radio-cephalic AVF seven years ago. There were three true aneurysms in AVF. Staple aneurysmorrhaphy was done under general anesthesia. A longitudinal skin incision was made over the aneurysmal portions of the AVF and extended onto normal-caliber vein. the AVF was completely mobilized from the surrounding tissue after proximal and distal control was obtained with vessel loops. A TATM AutosutureTM, Vascular Stapler with DST seriesTM Technology (30 mm-V3; Covidien, Norwalk, Conn) with a vascular load was applied across the aneurysm to approximate the normal-caliber adjacent vein, ~6 to 8 mm. Once satisfied with the vein diameter, the stapler was fired and the redundant wall excised. The staple line was reinforced with a running 5-0 polypropylene suture, even though hemostasis was good most of the time. The remodeled vein was positioned and tacked under the flap, with the staple line orientated inferiorly to avoid direct needle puncture.
Results : The preoperative volume flow in duplex ultrasound was measured irregularly from 360 ml/min to 650 ml/min. The postoperative volume flow in 1-month follow up was measured regularly 700 ml/min and the volume flow in 1-year follow up was improved 1050 ml/min. The diameter of AVF was maintained from 6 to 8 mm.
Conclusion : The staple aneurysmorrhaphy is an effective, safe, and durable procedure to preserve a functioning autogenous AVF with complicated aneurysmal degeneration.
Methods : The patient underwent right radio-cephalic AVF seven years ago. There were three true aneurysms in AVF. Staple aneurysmorrhaphy was done under general anesthesia. A longitudinal skin incision was made over the aneurysmal portions of the AVF and extended onto normal-caliber vein. the AVF was completely mobilized from the surrounding tissue after proximal and distal control was obtained with vessel loops. A TATM AutosutureTM, Vascular Stapler with DST seriesTM Technology (30 mm-V3; Covidien, Norwalk, Conn) with a vascular load was applied across the aneurysm to approximate the normal-caliber adjacent vein, ~6 to 8 mm. Once satisfied with the vein diameter, the stapler was fired and the redundant wall excised. The staple line was reinforced with a running 5-0 polypropylene suture, even though hemostasis was good most of the time. The remodeled vein was positioned and tacked under the flap, with the staple line orientated inferiorly to avoid direct needle puncture.
Results : The preoperative volume flow in duplex ultrasound was measured irregularly from 360 ml/min to 650 ml/min. The postoperative volume flow in 1-month follow up was measured regularly 700 ml/min and the volume flow in 1-year follow up was improved 1050 ml/min. The diameter of AVF was maintained from 6 to 8 mm.
Conclusion : The staple aneurysmorrhaphy is an effective, safe, and durable procedure to preserve a functioning autogenous AVF with complicated aneurysmal degeneration.
책임저자: Sung Woon Chung
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Republic of Korea
발표자: Up Huh, E-mail : tymfoo82@gmail.com