56 - Communication libre
Vascular Access / Vein
3 juin 2021, 17:35 - 19:05, Stream 3: SSCVasculaire & SSCViscérale
Challenges of percutaneous closure of temporary arteriovenous fistula
A. Zdoroveac1, R. Marti1, L. Gürke2, A. Isaak1, Presenter: A. Zdoroveac1 (1Aarau, 2Basel)
Surgical thrombectomy (VT) remains a valid therapeutic option in selected patients with DVD to prevent post-thrombotic syndrome. The creation of a temporary arteriovenous fistula (AVF) to reduce the risk for recurrent thrombosis is often part of the procedure. Closure of the AVF is recommended 8-12 weeks postoperatively. The surgical approach increases the risk of procedure-related complications such as impaired wound healing, infection or lymphatic fistula. Therefore, we evaluated and applied a minimally invasive technique using standard closure devices (CD).
Three patients received a temporary AVF using the great saphenous vein as a part of complex venous thrombectomy and reconstruction procedures in our case series. Three months after surgery, venous patency was confirmed by ultrasound (US), and the AVF was closed in local anesthesia in all patients. Our first procedure was planned according to the preoperative 3-D print and was as follows: to puncture the arterial ostium of AVF under US-guidance, to introduce the Proglide® CD over the guidewire into the SFA, and to close the arterial anastomosis of the AVF.
In one case, we found a residual flow in the AVF after the closure with Proglide®. We accomplished fistula closure with Femoseal® after puncturing the AVF in its middle segment. In the second case, we could detect a transformation of the arterialized duplex signal into a regular venous flow pattern in the femoral vein, but there was still residual flow in AVF that lead to conversion due to massive scar tissue. In the third case, a short AVF of approximately 2 cm was still open after two closure attempts with Proglide® and Femoseal®, and surgical closure was mandatory.
Redo- surgery in the groin is associated with a high risk of infection and lymphatic fistula. It is, therefore, an enticing idea to close the AVF in a minimally invasive manner. We managed to close one AVF percutaneously. The major challenges are handling CD in scar tissue and poor US visualization of the anatomical structures. To conclude, planning percutaneous closure of temporary AVF starts during its creation. AVF should be long enough and, if technically possible, outside the main surgical area to reduce scar formation. Expert skills for US-guided puncture and application of percutaneous CD are mandatory.