From the Guidelines
Dialysis arteriovenous fistula rupture is a medical emergency that requires immediate attention, and the management involves endovascular interventions, such as balloon angioplasty, stent graft or stent placement, and thrombectomy, as the first-line treatment.
Management of Dialysis Arteriovenous Fistula Rupture
- The primary goal is to restore patency and prevent further complications, such as thrombosis, infection, and ischemia.
- Endovascular interventions are the preferred treatment option, with a clinical success rate of 75% to 94% 1.
- Balloon angioplasty is a commonly used technique to treat stenoses and restore blood flow, with a reported cumulative patency rate of 71% to 82% at 3-6 months 1.
- Stent graft or stent placement may be used to treat complex lesions or to maintain patency, with a reported cumulative patency rate of 54% to 77% at 6-12 months 1.
- Thrombectomy is used to remove thrombi and restore blood flow, with a reported clinical success rate of 75% to 94% 1.
- Surgical consultation may be necessary in cases where endovascular interventions are not possible or have failed, and surgical revision or creation of a new access may be required 1.
Key Considerations
- Early diagnosis and intervention are crucial to prevent further complications and improve outcomes, with a goal of restoring patency within 24 to 48 hours 1.
- Individualized approach is necessary to determine the best course of treatment, taking into account the patient's specific needs and the type of lesion present 1.
- Monitoring and surveillance are essential to detect any signs of access dysfunction or thrombosis, and to prevent complications 1.
From the Research
Management of Dialysis Arteriovenous Fistula Rupture
- The management of dialysis arteriovenous fistula rupture typically involves emergency surgery to prevent further complications 2, 3, 4.
- Surgical options for managing arteriovenous fistula rupture include partial resection of the aneurysm and anastomosis 2, or ligation of the aneurysm with resection of the aneurysmal segment and maintaining arterial continuity 3, 4.
- In some cases, arterial ligation may be performed, especially in infected cases 3.
- Nonsurgical methods, such as stenting, may also be used to manage venous rupture or perforation during angioplasty of malfunctioning hemodialysis grafts and fistulas 5.
- Preventive measures, such as proper angioplasty balloon sizing, can help reduce the risk of rupture or perforation 5.
- Early detection and presentation to a healthcare setup can offer a better prognosis for limb salvage in the long term and decrease the incidence of morbidity and mortality 3.
Common Causes of Arteriovenous Fistula Rupture
- Aneurysm formation is a common cause of arteriovenous fistula rupture 2, 3, 4.
- Rupture of the aneurysm can occur suddenly, often after haemodialysis 2.
- Erroneous ways of cannulation and lack of awareness of fistula care can contribute to arteriovenous fistula complications, including rupture 3.
Outcomes of Surgical Management
- Successful surgical treatment of arteriovenous fistula rupture can allow for regular haemodialysis to continue 2.
- Arterial ligation and resection of the aneurysmal segment can be performed with minimal complications 3, 4.
- Nonsurgical methods, such as stenting, can also be effective in managing venous rupture or perforation 5.