Results of the Treatment of Complications of Arterio - Ventricular Fistula in the Upper Extremities at Sina Hospital (Tehran)

Introduction & Arterio - Ventricular fistula (AVF) is the choice route for hemodialysis. The complications arising from arterio -ventricular fistula include fistula aneurismal changes and steal syndrome. In this article we introduce 2 new methods for controling the complications in the side to side fistula of upper extremities. This case series study we ligated the vein at both proximal and distal ends in patients with aneurismal changes. Then the aneurismal vein was cut and released at both ends, and using point pressure the aneurismal contents was emptied, and after repair compression bandage was performed for a week. In another method, patients suffering from steal syndrome, with elbow side to side AVF, were evaluated by upper extremity Doppler sonography and the upper extremity perforan vein was ligated. In aneurismal changes after a week from compression bandage, fibrosis formation in the site, aneurism was eliminated and no complication was found in the follow up. In the case of Steal syndrome, an increase in the blood pressure was noticed in perform vein and by closing this vein we could control the steal phenomenon. Signs disappeared in all the patients and AVFs were saved in 80% of the cases. Our findings shows that in treating patients suffering from steal syndrome in perforating side to side fistula, vein closure is useful. Furthermore, cutting the perforating vein can stop the expansion of the syndrome. In patients suffering from aneurismal changes, no complications were seen in the follow up.