AVOID THE CATHETER IN THE TREATMENT OF ANEURYSMS

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E-Poster

https://storage.unitedwebnetwork.com/files/1099/3f2409e2d83b4196497b1c08744c1f53.pdf

Abstract Title

First Name *

Arturo

Last Name *

Vizcarra

Co-author 1

Abdullah Alhaizaey aalhizaey@hotmail.com Aseer Central Hospital CADIOVASCULAR SURGERY Abha Saudi Arabia

Co-author 2

Adrian Torrens adriantorrerren@hotmail.com SCIRE CARDIOVASCULAR SRL Cardiovascular Junín Buenos Aires

Co-author 3

Javier Rodriguez Ascencio javierhrodrigueza@gmail.com Hospital Vicente López y Planes Vascular Gral. Rodríguez Buenos Aires

Co-author 4

Mansour Aljaafari Man-s-uor@msn.com Aseer Central Hospital Vascular Surgery Abha Saudi Arabia

Co-author 5

José Scapuzzi jscapuzzi@gmail.com King Khalid General Hospital Nephrology Hafr Al Batin Cluster

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

- The increasing prevalence of End-stage renal disease patients is rising all over the world.

- The challenge is to be able to maintain access, especially in young patients.

- Aneurysms and proximal stenosis are common complications in AVF.

- Current standard of care involves surgical intervention to repair these complications.

- Traditional treatment is to close the aneurysm, lose this access, or insert a synthetic graft.

- Research is lacking on the use of plastic surgery with patient-own tissues to preserve access.

- They are a source of thrombi, they are aesthetic problems,

- More serious complications, such as rupture, which can have catastrophic consequences.

The surgeon's challenge :

-maintaining useful access to continue dialysis

- avoiding the temporary catheter.

What are the outcomes and benefits of this approach?

The objective is to perform plastic surgery with the patient's own tissues to preserve vascular access and avoid catheter insertion.

Methods

A retrospective cohort study was conducted to evaluate the outcomes of patients who underwent surgical repair for aneurysms.

The study included a total of 2,352 surgeries, performed between April 2016 and July 2023

Of these , 87 were aneurysms and the patients average age ranged from 25 to 79 years old.

The inclusion criteria for the study were patients who underwent surgical repair for aneurysms.

Diagnosis: by physical examination, AVF semiology, Doppler and fistulography for central stenosis.

In 5 patients (5.7% of the aneurysms), plastic surgery of the aneurysms was not performed, since 3 had non-functioning AVFs, 1 due to infection, 1 due to long stenosis of the aneurysm.

The operated patients had aneurysms between 3 and 8 cm diameter

In 8 patients, cephalic vein arch angioplasty was performed at the same time as the aneurysm repair 9.1%

The rest of the stenoses were immediate to the aneurysm, so they were resolved with the same plastic surgery and re-anastomosis.

25 patients did not have stenosis, and it can be attributed to the nature of their tissues or arterial hypertension added to repeated punctures in the same spot, 28.7%

With our technique, the repair is planned in 2 stages,

Firstly, a segment that can be punctured in 45 days.

Secondly, the remaining segment

Results

A total of 87 participated in the study, in 82 plastic surgery was performed 94% of the aneurysms.

In 2 patients, the complete aneurysm was repaired, and a catheter was placed for 45 days.

In the 80, remaining 92%, it was successful repaired in 2 stages, and did not require a catheter.

We have used a meticulous technique:

we had no hematomas

we had no infections

In patients with stenosis, they were previously repaired so that they do not recur.

The aneurysm plastics were punctured successfully after 30 to 45 days.

5 cases (5.7%) recurred in a mild manner, after 2 years, patients who did not clearly have proximal stenoses. So far no need to reoperate.

The study is being continued to evaluate at least over a 2 years period to monitor the results of plastic surgery.

The study the outcomes found that plastic surgery is more effective in repairing aneurysms.

We have to wait for long-term results of this surgical technique; the next step is to conduct a larger multicenter study to confirms this findings.

Conclusions

- A proximal stenosis, it is recommended to repair before, or at the same aneurysm surgery.

- Taking care of the patient's venous capital.

IT IS A TECHNIQUE THAT ALLOWS:

1 - MAINTAIN ACCESS

2 - DO NOT USE PROSTHESIS

3 - AVOID CATHETER IMPLANTATION

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