The temporary arteriovenous fistula in venous reconstructive surgery

Area of Science:

• Vascular Surgery
• Venous Thrombosis Management

Background:

• Acute ilio-femoral venous thrombosis poses significant challenges in vascular surgery.
• Effective management strategies are crucial for preventing complications like graft thrombosis and ensuring vein patency.

Purpose of the Study:

• To describe the role of temporary arteriovenous fistulas (AV-fistulas) in venous reconstructive surgery.
• To evaluate the efficacy of AV-fistulas in increasing blood flow, preventing thrombosis, promoting healing, and developing collaterals.
• To present outcomes of managing acute ilio-femoral venous thrombosis using thrombectomy and temporary AV-fistulas.

Main Methods:

• The study describes the application of temporary AV-fistulas in venous reconstructive surgery.
• A series of 120 operations for acute ilio-femoral venous thrombosis involving thrombectomy and temporary AV-fistulas were performed.
• A prospective randomized study compared surgical intervention with conservative treatment.

Main Results:

• No mortality from fatal pulmonary embolism was observed in the 120 operations.
• In the randomized study, 76% of operated patients maintained patent iliac veins compared to 35% in the conservative group.
• Ten patients with iliac vein obstruction underwent immediate reconstruction with PTFE grafts and AV-fistulas; three grafts remained functional after 7, 15, and 56 months.

Conclusions:

• Temporary AV-fistulas are effective in improving outcomes for venous reconstructive surgery, particularly in acute ilio-femoral venous thrombosis.
• The use of AV-fistulas in conjunction with thrombectomy significantly enhances iliac vein patency rates compared to conservative management.
• This approach offers a viable solution for immediate reconstruction in iliac vein obstruction, with potential for long-term graft function.