초록접수 현황
| 16F-150 | 구연 발표 |
Anastomotic Pseudoaneurysm Combined with Graft Thrombosis Following Interposition Arteriovenous Graft for Hemodialysis
Sun Kyun Ro, Seung Hyuk Nam, Chul Burm Lee
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Korea
Background : A pseudoaneurysm occurred at the anastomotic site of the hemodialysis graft is a rare complication following the arteriovenous access procedure. Because the anastomotic pseudoaneurysm is usually ascribed to the vulnerable vascular wall caused by graft infection, it seldom occurs without graft infection.
Methods : Among 157 vascular access procedures (123 arteriovenous fistulas, 34 arteriovenous grafts (AVGs)) performed in our hospital from April 2013 through July 2016, three cases (1.9%) of the anastomotic pseudoaneurysm occurring in the postoperative period were described in this study. Preoperative Doppler sonographies were performed in all cases for diagnosis and treatment plan.
Results : All three patients underwent interposition AVG for hemodialysis. Graft thrombosis occurred just prior to the development of anastomotic pseudoaneurysm in all cases. Two cases in which the complications occurred in the early postoperative period were associated with graft infection, whereas any evidences suggesting graft infection were not revealed in the other case. In two cases presenting graft infection, Pseudomonas aeruginosa was confirmed as a pathogen through wound culture. Two patients with graft infection underwent removal of the AVG and repair of the affected artery and the other patient underwent transposition of the inflow of the AVG from radial to brachial arteries.
Conclusion : Graft thrombosis leading to elevated pressure at the anastomotic site of the AVG may contribute to the anastomotic pseudoaneurysm. If a pulsatile mass-like lesion was noted at the anastomotic site of hemodialysis graft, a strong probability of the anastomotic pseudoaneurysm should be considered especially in patients whose grafts were thrombosed with or without the evidence of graft infection.
Methods : Among 157 vascular access procedures (123 arteriovenous fistulas, 34 arteriovenous grafts (AVGs)) performed in our hospital from April 2013 through July 2016, three cases (1.9%) of the anastomotic pseudoaneurysm occurring in the postoperative period were described in this study. Preoperative Doppler sonographies were performed in all cases for diagnosis and treatment plan.
Results : All three patients underwent interposition AVG for hemodialysis. Graft thrombosis occurred just prior to the development of anastomotic pseudoaneurysm in all cases. Two cases in which the complications occurred in the early postoperative period were associated with graft infection, whereas any evidences suggesting graft infection were not revealed in the other case. In two cases presenting graft infection, Pseudomonas aeruginosa was confirmed as a pathogen through wound culture. Two patients with graft infection underwent removal of the AVG and repair of the affected artery and the other patient underwent transposition of the inflow of the AVG from radial to brachial arteries.
Conclusion : Graft thrombosis leading to elevated pressure at the anastomotic site of the AVG may contribute to the anastomotic pseudoaneurysm. If a pulsatile mass-like lesion was noted at the anastomotic site of hemodialysis graft, a strong probability of the anastomotic pseudoaneurysm should be considered especially in patients whose grafts were thrombosed with or without the evidence of graft infection.
첨부파일 : Table.docx
책임저자: Sun Kyun Ro
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Korea
발표자: Sun Kyun Ro, E-mail : skro@hyumc.com