Arteriovenous Fistula Resection and Arterial Repair

Generally, the range of arteriovenous fistula is not large, and end-to-end anastomosis is feasible If the arterial defect is long after resection, it must be transplanted with autologous vein or artificial blood vessel. Sometimes, the tumor sac of arteriovenous tumor is small, and the damage of the arterial wall is rare. The tumor sac can also be wedge-shaped and the artery can be directly sutured. Treatment of diseases: congenital arteriovenous fistula, posterior arteriovenous fistula Indication Generally, the range of arteriovenous fistula is not large, and end-to-end anastomosis is feasible If the arterial defect is long after resection, it must be transplanted with autologous vein or artificial blood vessel. Sometimes, the tumor sac of arteriovenous tumor is small, and the damage of the arterial wall is rare. The tumor sac can also be wedge-shaped and the artery can be directly sutured. Surgical procedure 1. Control the proximal arteries, incisions and exposures with the same vein repair arteries. 2. Separation of the tumor sac: separate the proximal and distal ends of the artery and vein, respectively, each winding a gauze band to control blood flow; or control the artery with a blood vessel clamp. Carefully separate, ligature, and sever the branches of the venous and arterial vessels [Fig. 2 (1)]. The proximal end of the vein is partially blocked first, and then completely blocked after a few minutes; then the distal end of the vein and the proximal and distal end of the artery are blocked later (Fig. 2 (2)), so as not to suddenly increase the burden on the heart. The tumor sac is completely separated along the vessel wall. 3. Resection of the tumor capsule and anastomosis (1) Cut the tumor sac close to the pupil and try to keep a healthy artery. After resection, the arterial defect is generally only 1 to 2 cm long [Fig. 2 (3)], and can be used as a direct end-to-end anastomosis without significant tension [Fig. 2 (4)]. (2) The venous stump is firmly ligated and then sewed. (3) In some cases, when the arterial injury is large, the wall damage is excessive, or the proximal end is over-expanded, it needs to be extensively removed. After resection, if the arterial defect is too long, a vascular graft is required [Fig. 2 (5)].