Name of the Procedure:

Revision, Open, Arteriovenous Fistula; with Thrombectomy, Autogenous or Nonautogenous Dialysis Graft (Separate Procedure)

Summary

In this surgical procedure, doctors correct problems in a previously created arteriovenous (AV) fistula or dialysis graft. These issues usually involve blood clots blocking the blood flow. The surgeon accesses the AV fistula or graft, removes the clots, and performs necessary repairs to ensure proper function.

Purpose

This procedure is designed to restore adequate blood flow in an AV fistula or dialysis graft, which is essential for patients undergoing hemodialysis. The expected outcome is improved functionality of the fistula or graft, thereby ensuring effective dialysis treatment.

Indications

• Poor blood flow or blockage in the AV fistula or dialysis graft.
• Ineffectiveness of dialysis treatments due to poor access.
• Symptoms such as swelling, pain, or non-functional dialysis ports.
• Imaging or tests indicating thrombus or stenosis in the fistula or graft.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications (e.g., blood thinners) may be required.
• Pre-operative tests like ultrasound, blood tests, or fistulograms are often performed to assess the condition of the AV fistula or graft.

Procedure Description

1. The patient is given either local or general anesthesia.
2. The surgeon makes an incision to expose the affected AV fistula or graft.
3. Thrombectomy is performed by removing any blood clots present.
4. The fistula or graft is revised, which may involve repairing or replacing segments.
5. The incision is closed with sutures, and the area is dressed.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity and extent of the revision required.

Setting

This procedure is generally performed in a hospital operating room or a surgical center equipped with specialized vascular surgery facilities.

Personnel

• Vascular surgeon
• Surgical nurse
• Anesthesiologist
• Support staff like scrub techs and circulator nurses

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Recurrence of clot formation.
• Injury to surrounding structures such as nearby blood vessels or nerves.
• Rarely, loss of the fistula or graft, necessitating placement of a new access.

Benefits

• Restoration of proper blood flow, ensuring the AV fistula or graft functions effectively for dialysis.
• Potential improvement in dialysis efficiency and patient quality of life.
• Reduced symptoms such as swelling and pain at the access site.

Recovery

• Patients may need to stay in the hospital for observation overnight.
• Post-procedure instructions include keeping the surgical site clean, monitoring for signs of infection, and limiting arm activity.
• Most patients can resume normal activities within a week, though heavy lifting and strenuous activities should be avoided.
• Follow-up appointments are necessary to check the fistula or graft function and ensure proper healing.

Alternatives

• Percutaneous thrombectomy, a less invasive procedure using catheters.
• Creation of a new AV fistula or placement of a new dialysis graft if the current one fails.
• Different forms of dialysis access, such as tunneled dialysis catheters.

Patient Experience

During the procedure, the patient will be under anesthesia, so they will not feel pain. Post-procedure, some discomfort or mild pain at the incision site can be expected, which can be managed with prescribed pain medications. Swelling and bruising might be observed, typically resolving in a few days. Patients should follow all post-operative care instructions to ensure a smooth recovery.