From the Guidelines
A fistula revision is a surgical procedure performed to repair or modify an existing arteriovenous fistula that has developed complications or is not functioning properly, and it is recommended when the fistula is unable to sustain adequate HD blood flow, as evidenced by the inability to achieve the prescribed Kt/V within a reasonable HD duration 1.
Indications for Fistula Revision
The primary indication for a fistula revision is inadequate blood flow, which can result in inadequate dialysis, increasing patient mortality and morbidity 1. Other indications include stenosis, thrombosis, aneurysm formation, or structural problems with the fistula.
Techniques Used in Fistula Revision
The specific technique used in a fistula revision depends on the problem being addressed and may include:
- Angioplasty to open narrowed segments
- Thrombectomy to remove clots
- Surgical revision to repair structural problems
- Creation of a new anastomosis (connection between artery and vein) 1
Importance of Fistula Revision
Fistula revisions are necessary because maintaining a functional vascular access is essential for effective hemodialysis treatment and patient survival 1. A well-functioning fistula can improve the quality of life for patients with end-stage renal disease by allowing for more efficient and effective dialysis.
Preoperative Evaluation
Careful preoperative evaluation is crucial to document data on anatomic and functional status of the arterial vasculature, including flow in the brachial artery 1. This evaluation can help identify potential problems and guide the surgical approach.
Postoperative Care
After a fistula revision, patients should protect the revised fistula from pressure, avoid lifting heavy objects with that arm for several weeks, and attend follow-up appointments to check fistula function 1. Monitoring for bleeding, infection, and ensuring the fistula is functioning properly is also essential.
From the Research
Definition of Fistula Revision
- A fistula revision refers to a surgical or endoscopic procedure aimed at repairing or revising an existing fistula, which is an abnormal connection between two epithelial surfaces 2.
- Fistulae can form due to various causes, including surgical intervention, foreign bodies, bowel diverticula, Crohn's disease, malignancy, radiation, and infection 2.
Types of Fistula Revision
- Surgical revision: This involves a surgical procedure to repair or revise the fistula, and may be indicated in cases where non-operative management has failed or is not feasible 3, 4.
- Endoscopic revision: This involves the use of endoscopic devices and techniques to repair or revise the fistula, and may be used as an alternative to surgical revision in some cases 3, 5, 6.
Indications for Fistula Revision
- Failed non-operative management: In cases where non-operative management has failed to close the fistula, revision may be necessary 2, 4.
- Chronic fistula: Revision may be indicated in cases of chronic fistula, where the fistula has failed to close despite non-operative management 5, 4.
- Complications: Revision may be necessary in cases where the fistula is causing complications, such as infection, sepsis, or organ failure 2, 3.
Techniques for Fistula Revision
- Laparoscopic revision: This involves the use of laparoscopic techniques to revise the fistula, and may be used to perform procedures such as total gastrectomy or fistulo-jejunostomy 4.
- Endoscopic fistula closure: This involves the use of endoscopic devices and techniques to close the fistula, and may be used as an alternative to surgical revision in some cases 3, 5, 6.