Major complications of angioaccess surgery
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J L Ballard1, T J Bunt, J M Malone
1Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85010.
Insights
Major complications from angioaccess procedures, including Cimino-Brescia fistulas and grafts, require significant surgical intervention and carry notable mortality risks. Careful management is crucial to minimize patient morbidity and mortality.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Angioaccess is critical for hemodialysis, but complications can be severe.
- Vascular access procedures include fistulas, grafts, and central lines.
- Complications can range from minor issues to life-threatening events.
Purpose of the Study:
- To determine the frequency of major limb- or life-threatening complications from angioaccess procedures.
- To assess the impact of these complications on vascular surgery caseloads.
- To evaluate mortality and long-term morbidity associated with angioaccess complications.
Main Methods:
- Retrospective review of 435 angioaccess procedures over 4 years.
- Analysis of complications including Cimino-Brescia fistulas, PTFE grafts, thrombectomy/revisions, and central lines.
- Categorization of complications into major limb- or life-threatening events requiring surgical repair.
Main Results:
- 77 operations for major complications in 53 patients were identified.
- 5 patients required major vascular repair or emergency thoracotomy for central line complications.
- 18% of the angioaccess caseload was used for complication repair, with significant in-hospital (11%) and long-term (23%) mortality.
- 4% of patients experienced debilitating long-term symptoms.
Conclusions:
- Major complications from angioaccess procedures represent a substantial burden on surgical resources.
- Significant mortality and morbidity rates are associated with these complications.
- While most complications are repairable, a small percentage results in severe long-term disability.
Abstract:
Angioaccess procedures at one institution over a 4-year period were retrospectively reviewed to ascertain the frequency of major limb- or life-threatening complications. A total of 435 angioaccess procedures were performed, including 81 Cimino-Brescia fistulas, 166 polytetrafluoroethylene grafts, and 111 thrombectomy/revisions. There were 77 operations for major complications in 53 patients. In addition, five patients required major vascular repair or emergency thoracotomy for complications of central hemodialysis line placement. A significant portion (18% of this series) of the total angioaccess caseload of a vascular surgeon will be utilized in the repair of major complications. The in-hospital (6 patients, or 11%) and long-term (12 patients, or 23%) mortality rates are significant. Although most complications can be repaired without limb loss and with shunt salvage, a small percentage (in our study three patients, or 4%) will have debilitating long-term symptoms.