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, typically due to inadequate blood flow, stenosis, or thrombosis, 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 fistula revision is inadequate blood flow, which can result in inadequate dialysis, increasing patient mortality and morbidity 1. Other indications include stenosis, thrombosis, and aneurysm formation.
Causes of Fistula Dysfunction
Fistula dysfunction can be caused by various factors, including arterioatherosclerotic narrowing of the feeding artery, stenosis of the artery, and impaired flow in the anastomotic area 1.
Therapeutic Options
Therapeutic options for fistula revision include interventional angioplasty, surgical revision, or creation of a new AV anastomosis at a more proximal location 1. The choice of therapeutic option depends on the type and location of the lesion, as well as local expertise.
Importance of Fistula Revision
Fistula revision is crucial for preserving existing vessels and extending the lifespan of the dialysis access, which is essential for patients requiring long-term hemodialysis 1. Regular follow-up ultrasounds are important to ensure continued fistula patency.
Key Considerations
Key considerations for fistula revision include careful preoperative evaluation, documentation of anatomic and functional status of the arterial vasculature, and selection of a more proximally located site for creation of the AV anastomosis, if necessary 1.
From the Research
Definition of Fistula Revision
A fistula revision refers to a surgical or endoscopic procedure aimed at repairing or revising a fistula, which is an abnormal connection between two body parts, such as between the intestine and the skin or between two organs [(2,3,4,5,6)].
Types of Fistula Revisions
There are different types of fistula revisions, including:
- Endoscopic revision, which uses flexible endoscopic devices and technology to manage gastrointestinal fistulae [(2,3,4)]
- Surgical revision, which involves open or laparoscopic surgery to repair or revise the fistula [(5,6)]
- Laparoscopic revision to total gastrectomy or fistulo-jejunostomy, which is a definitive surgical procedure for chronic gastric fistula after laparoscopic sleeve gastrectomy 5
Indications for Fistula Revision
Fistula revision is indicated for patients with chronic fistulae that have failed to close with conservative management or endoscopic treatment [(2,3,4,5)]. The procedure is also indicated for patients with complications related to the fistula, such as infection, nutritional deficiency, or organ failure 2.
Techniques and Devices Used in Fistula Revision
Various techniques and devices are used in fistula revision, including:
- Endoscopically deployable stents [(2,4)]
- Endoscopic suturing devices [(2,4)]
- Through-the-scope and over-the-scope clips [(2,4)]
- Sealants and fistula plugs [(2,4)]
- Laparoscopic surgical techniques, such as proximal neo-anastomosis and thrombectomy [(5,6)]