乳内动脉在70岁以上患者冠状动脉旁路移植手术中的应用

目的 总结70岁以上患者冠状动脉旁路移植手术中应用乳内动脉的利弊.方法 2010年7月1日至2012年8月20日,1471例70岁以上患者行单纯冠状动脉旁路移植手术共,占同期6156例单纯CABG手术者的23.10％.其中男1030例,女441例,年龄(73.3±3.9)岁.1395例采用非体外循环冠状动脉旁路移植术(off-pump CABG),76例采用体外循环(on-pump CABG),其中12例采用体外循环不停跳(on-pump beating heart CABG).旁路移植移植旁路血管(3.12±0.68)支.按移植血管材料分为2组:A组:564例全部应用大隐静脉;B组:907例患者应用左乳内动脉建立与左前降支旁路移植手术,其中42例应用桡动脉及胃网膜右动脉进行全动脉化旁路移植手术,其余靶血管均应用大隐静脉作为血管移植物旁路移植.结果 A组死亡12例(2.12％),B组死亡19例(2.09％),组间差异无统计学意义.B组术后早期引流量明显高于A组,二次开胸止血、恶性心律失常、脑卒中、伤口愈合不良和IABP使用例数等指标两组之间差异均无统计学意义.结论 70岁以上高龄患者旁路移植冠状动脉旁路移植选择左乳内动脉作为左前降支的旁路移植旁路血管材料,不增加手术死亡和术后严重并发症的发生率.乳内动脉在远期通畅率方面的优势明显,建议70岁以上高龄患者旁路移植优先选择左乳内动脉作为左前降支的旁路移植旁路移植血管.     

Development of a fistula between an internal mammary artery graft and the pulmonary vasculature following coronary artery bypass grafting: Report of a case

We report herein the rare case of a 56-year-old man who gradually developed congestive cardiac failure 6 months after undergoing coronary artery bypass grafting and was found to have a fistula between the internal mammary artery and the pulmonary artery of the upper lobe diagnosed by selective left internal mammary arteriogram. A second sternotomy was performed and demonstrated dense adhesion between the fissure surrounding the internal mammary artery and the upper lobe, and the fistula was resected. We believe that the patient's increasing cardiac failure was almost certainly caused by coronary steal.     

Does the arteriovenous fistula in chronic haemodialysis patients stimulate endothelin-1 release?

Plasma endothelin-1 (ET-1)-like immunoreactivity was measured by radioimmune assay in predialysis plasma samples from 16 chronic haemodialysis patients (7 dialysing through arteriovenous (AV) fistulae and 9 using central venous cannulae for access), from 10 patients with functioning renal transplants (5 with AV fistulae and 5 without), and from 6 healthy subjects as controls. Among dialysis patients, ET-1 was greater in those with AV fistulae than in those using cannulae for dialysis (median (range), 5.5 (3.1) pM versus 3.7 (2.0) pM, P = 0.02), and in all haemodialysis patients ET-1 values were substantially greater than in normal controls (3.9 (3.2) pM versus 0.5 (0.1) pM; P = 0.001). In patients with functioning AV fistulae, ET-1 concentrations obtained directly from the AV anastomosis of the fistula (4.4 (3.0) pM) were less than those taken simultaneously from the contralateral arm (5.5 (3.1) pM; P = 0.04), while samples drawn from the venous side of the fistula were intermediate (4.6 (3.4) pM). In renal transplant recipients, ET-1 values did not differ significantly from those in control subjects (0.7 (1.9) pM versus 0.5 (0.1) pM, n.s.), but in these patients there was a significant difference between peripheral venous ET-1 in transplant patients with and without AV fistulae (0.8 (1.9) pM versus 0.6 (1.1) pM respectively, P = 0.04). The results suggest that the increased blood flow rate through the arterialized venous circulation in the fistula arm stimulates increased ET-1 release in these patients, and that this accounts, at least in part, for the increased ET-1 found in the patients with functioning AV fistulae.     

Two-stage brachiobasilic arteriovenous fistula for chronic haemodialysis access

BACKGROUND: Many haemodialysis patients are unable to have or maintain distal upper limb arteriovenous (AV) fistulas because of inadequate veins or arteries and therefore require more proximal access. We have reviewed our experience with a two-stage brachiobasilic AV haemodialysis fistula fashioned in the arm. METHODS: Ninety-one brachiobasilic AV fistulas were fashioned in 87 patients between August 1999 and October 2004. Four AV fistulas failed because of early thrombosis. The second stage 'superficialization' was carried out at a median (range) of 73 days (32-1827 days) after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the anteromedial aspect of the arm and transposing it beneath the skin incision. RESULTS: Primary and secondary patency rates were 87 and 89%, respectively, at 1 year and 78 and 84%, respectively, at 2 years. Early complications included infection (3%) and haemorrhage (4%) and late complications included thrombosis (15%) and stenosis (14%). CONCLUSION: The two-stage superficialized brachiobasilic AV fistula described in this article has good patency. The operative techniques are straightforward, have relatively low complication rates and result in a large-diameter fistula on the anteromedial aspect of the arm allowing easy and painless cannulation for haemodialysis.     

Bilateral internal thoracic artery harvesting; anatomical variations to be considered

Introduction Predictable intrathoracic course, anatomical proximity to heart and long-term patency has made Internal thoracic artery (ITA) a conduit of choice in coronary artery bypass grafting (CABG). Its frequent bilateral use has necessitated the need to have a comparative knowledge of surgical anatomy of ITA on both sides. Methods A random study was conducted on 100 adult human cadavers. Sternocostal wall was removed and fixed in 10% formalin and dissected for detailed anatomy of ITA. All observations were expressed as mean ± 2SD and appropriate statistical analysis conducted. Observations ITA originated in common trunk with other branches of subclavian artery in 12% on right side and 4% on left. Mean length of right ITA was 20.15 ± 1.22 cm, left 19.83 ± 1.66 cm in 28% of cases where bilateral ITA terminated in 6th Intercostal space (ICS). On pattern of origin of sternal branches from ITA 3 groups were observed. Group-I-some sternal branches arising from common trunk of ITA on both sides (24%), Group-II-some sternal branches arising from common branch of ITA on one side only (54%), Group-III-all sternal branches arising directly from ITA on both sides (22%). Phrenic nerve crossed anterior to ITA on both sides in 52%, posteriorly in 14% and in remaining it crossed anteriorly on one side and posteriorly on other. Conclusion Variations as described in our study in relations to phrenic nerve, level of bifurcation and sternal blood supply must be kept in mind while harvesting bilateral ITA to reduce risk of sternal dehiscence by preserving the sternal blood supply from common trunk and to prevent post operative phrenic nerve palsy.     

Relationship between obstruction of arteriovenous fistula and plasma level of endothelin-1 in long-term haemodialysis patients

Summary: The relationship between the patency status of the autogenous arteriovenous (A-V) fistula and the plasma level of endothelin-1 (ET-1) was studied in 41 patients who had been receiving routine longterm haemodialysis for more than 10 years. the ET-1 level in the haemodialysis patients (mean ± s.d.=2.1 ± 0.9 pg/mL) was significantly elevated compared with that in healthy controls ( n =16; 1.1 ± 0.4 pg/mL; P < 0.01). the patients were classified into two groups according to whether the original A-V fistula had remained patent for more than 10 years or had been repaired due to frequent (more than twice) obstruction. Among all 41 patients, 21 were receiving recombinant human erythropoietin (rHuEpo) intravenously (i.v.). In the rHuEpo-treated group, the plasma ET-1 ( n =21; 2.4 ± 0.8 pg/mL) was significantly elevated than that in the rHuEpo-untreated group ( n =20; 1.9 ± 0.9 pg/mL; P<0.05). After exclusion of the 21 rHuEpo-treated patients, the ET-1 level in the repaired fistula group ( n =11; 2.3 ± 0.9 pg/mL) was significantly higher than that in the patent original fistula group ( n =9; 1.3 ± 0.7 pg/mL; P <0.02). Based on these results, we conclude that ET-1 shows a close relation to venous stenosis of the A-V fistula which may be due to its vasoconstrictive and smooth muscle cell-proliferating effects.     

Bilateral pedicled internal thoracic artery grafting

Background: Pedicled bilateral internal thoracic artery grafting (BITA) has been discouraged in historical high-risk groups such as diabetes mellitus (DM), renal failure, old age, and obesity because of reported high incidence of mediastinitis. However, considering the fact that there are abundant short and long-term results including angiography study about the conventional pedicled grafts, it might be worthwhile reassessing the results of pedicled BITA grafting with modern techniques by a disciplined surgical team before abandoning the method. Methods: Between September 1989 and September 1999, 1371 patients underwent isolated coronary artery bypass grafting (CABG) in Kumamoto central hospital. Of these patients, 558 patients who had bilateral ITA strategy (mean age 63.0±9.2 years, 13–79) were studied. The method of harvest of ITAs is consistently the use of conventional pedicled grafts. The use of bone wax and unnecessary electrocautery injury to the periostium or cartilage were avoided as much as possible. The only change in the surgical technique in the study period is the application of the pinpoint hemostasis for the presternal tissues from August 1997 (late period). Results: In late period, there were significantly more patients with sternal sepsis risk factors such as diabetes mellitus (early: late; 19.3% vs. 34.8%, P<0.00003), and renal failure (0.3 vs. 9.7%, P<0.0001) as well as patients who had gastroepiploic artery grafting (16.9 vs 48.5%, P<0.0001) and those who required aortic non-touch technique (2.1 vs. 7.9%, P<0.001). The percentage of the patients receiving BITA grafting among the isolated CABG patients increased in the late period from 31.7% (331/1043) to 69.2% (227/328) (P<0.001), reflecting that a more aggressive approach towards bilateral ITA and arterial grafting has been taken in the late period. Overall operative mortality was 1.1% (n=6). Mediastinitis occurred in seven patients (1.3%). Of these, only one mediastinitis occurred in late period (0.4%). No mediastinitis occurred in 23 chronic renal dialysis patients. Among the 143 DM patients, there were three mediastinitis (2.1%). Of three, only one occurred in late period, yielding 1.3% mediastinitis rate. There was one mediastinitis (0.7%) among 134 elderly patients more than 70 years of age. Univariate analysis identified obesity as a risk factor for mediastinitis. And there was a trend of decreasing mediastinits in late period but did not reached a statistical significance (P<0.2). Multivariate analysis identified obesity and arteriosclerosis obliterates as independent risk factors. Neither diabetes mellitus, dialysis, female gender, nor old age were significant independent predictors of mediastinitis. Despite the significantly high percentage of high-risk patients in late group, there were no significant difference in mortality and morbidity between the two groups. Conclusion: Pedicled BITA grafting is feasible with acceptable morbidity and shouldn't be abandoned even in high-risk patients such as DM, old age, and dialysis, especially combined with pinpoint-hemostasis, avoiding excessive use of bone wax, and strict aseptic technique. These point require a surgical team familiar with these techniques to maintain adequate skills in conduit procurement.     

A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis

Introduction: Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure. Methods: Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end-to-side variety. Parameters studied were age, gender, diabetes mellitus, hypertension prior to end-stage kidney disease (ESKD), site of fistula, blood flow rate, venous pressure, dialysis vintage and frequency, needle gauge used during dialysis, year of fistula creation, and details of fistula failure. Findings: The 6-month, 1-year and 2-year AVF survival rates were 98.41%, 95.01%, and 89.57%. Failure rates were 17.2%, 5.5%, 26.8%, and 14.4% for dominant radial, non-dominant radial, dominant brachial and non-dominant brachial respectively (P < 0.001). Using a larger needle size had better AVF survival rate (P < 0.05). All other factors had no significant correlation with AVF failure. Conclusion: There were no statistically significant differences in AVF patency with respect to gender, age, blood flow rate, presence of diabetes mellitus or systemic hypertension. A distally placed AVF in the nondominant arm had the best survival rate. Using a larger needle size, specifically 15G during dialysis, was associated with lowest AVF failure.     

非体外循环与体外循环冠状动脉旁路移植血管中远期通畅率比较

目的 比较非体外循环不停跳与体外循环冠状动脉旁路移植手术后中远期移植血管的通畅率.方法 对同一术者行冠状动脉旁路移植手术后5年以上病例50例.按手术方式分为两组.第1组采用传统体外循环下进行冠状动脉旁路移植(体外循环组,25例);第2组采用非体外循环不停跳技术进行冠状动脉旁路移植(非体外循环组,25例).对所有病例进行冠状动脉造影随访,比较两组移植血管的通畅情况.结果 两组均男21例,女4例.第1组手术年龄(55.4±8.9)岁;随访70～110个月,平均(86.52±12.48)个月;移植血管共83支,其中动脉移植血管41支,静脉移植血管42支,平均移植血管(3.32±0.63)支/例;随访移植血管通畅61支,狭窄6支,闭塞16支,动脉移植物通畅率为78.05%,静脉通畅率69.05%,总通畅率73.49%.第2组手术年龄(58.2±9.09)岁;移植血管共65支,其中动脉移植血管31支,静脉移植血管34支,平均移植血管(2.52±0.71)支/例,随访64～99个月,平均(82.68±12.48)个月;随访移植血管通畅47支,狭窄4支,闭塞14支,动脉移植物通畅率为74.19%,静脉通畅率70.59%,总通畅率72.31%.结论 非体外循环不停跳冠状动脉旁路移植手术移植血管中远期通畅率与传统体外循环手术一致,均可达到较好的中远期疗效.

Abstract：

Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting(CCABG). But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting ( group 1 ) and 25 patients received OPCAB ( group 2). All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was (55.4 ±8.9) years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction (EF) was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was (3.58 ± 0. 82) hours. Mean follow-up duration was ( 86.52 ± 12.48) months. 83 grafts were evaluated for patency ( open vs. closed) and were graded by Fitzgibbon as grade A ( excellent graft), B ( impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery), or O ( completely occluded). The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was (58.2 ± 9.09) years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction (EF) was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.     

34例非体外循环冠状动脉搭桥术

目的：报告３４例非体外循环下的冠状动脉搭桥术，。方法：秣在全麻常温下进行，正中切口２１例，左前外侧切口１１例，右前外侧切口和左胸骨旁切口各１例。单支病变１７例，双支病变１１例，三支病变６例；平均每例搭桥１．４支，其中１例同时激光打孔心肌血运重建。结果：全组无手术死亡平均手术时间３．１小时，平均带气管插管时间１０．９小时，２２例病人（６４．７％）不需输血，平均住院花费３．４万元。术后ＵＦＣＴ或ＭＲＩ     

不停跳冠状动脉旁路移植术在左主干病变病人中的应用

目的 探讨不停跳冠状动脉旁路移植术（0PCAB）在左主干病变病人中应用的可行性和特点。方法 2002年5月至2006年5月，97例伴有左主干病变的冠心病病人施行了OPCAB，同期为86例伴有左主干病变的冠心病病人行体外循环下的冠状动脉旁路移植术（CABG）。对两组病人术前、术后的临床资料进行对比分析。结果 OPCAB和CABG组术前平均年龄（68．1±4．9）岁对（64．3±6．5）岁，P〈0．05；术前慢性阻塞性肺疾病史10．3％对2．3％，P〈0．05；术前肌酐高于正常者5．2％对0，P〈0．05；术前脑梗塞病史12.4％对3．5％，P〈0．05。术后OPCAB和CABG组病死率为1．03％对1．16％，P：0．93；房颤发生率14．4％对27．9％，P=0．02。结论 对伴有左主干病变的冠心病病人行OPCAB临床效果良好。     

Off-pump coronary artery bypass grafting using in situ bilateral skeletonized internal thoracic arteries

Objective All arterial off-pump coronary artery bypass grafting (OPCAB) with in situ bilateral skeletonized internal thoracic arteries (ITAs) may become a standard procedure that would provide better long-term results without affecting early results. Methods Our study included 404 consecutive patients who underwent OPCAB with one or two ITAs. We compared the clinical results of 135 patients who underwent OPCAB using unilateral ITA (UITA group) to those of 269 patients using bilateral ITAs (BITA group). Results The average number of distal anastomoses was 3.07 in the UITA group and 3.47 in the BITA group (P < 0.01). Four operative mortalities occurred in the UITA group and two in the BITA group. There were no significant differences in morbidity between the two groups. Conclusion OPCAB using bilateral skeletonized ITAs is technically feasible, with good early results. Arterial OPCAB using in situ bilateral skeletonized ITAs may become a standard procedure in the future.     

Coagulation, fibrinolysis and fibrinolysis inhibitors in haemodialysis patients: contribution of arteriovenous fistula

BACKGROUND: End-stage renal disease (ESRD) patients, not uncommonly, mightexhibit thrombotic complications, as well as they may presentwith a bleeding diathesis. Changes in vessel wall and/or bloodflow in native arteriovenous fistula (AVF) might also augmentthese disarrangements, as vascular endothelium is predominantlyinvolved in the regulation of haemostatic pathways. OBJECTIVE: This study was designed to evaluate the state of coagulationand fibrinolysis and the role of AVF on haemostatic defects,in ESRD patients on maintenance haemodialysis. METHODS: Plasma samples for prothrombin fragment 1+2, thrombin-antithrombinIII complex, plasmin-₂ antiplasmin complex, tissue type plasminogenactivator antigen, urokinase type plasminogen activator antigen,u-PA activity, plasminogen activity, ₂-antiplasmin and ₂-microglobulinassays were obtained from AVF and contralateral large veinsof ESRD patients and from peripheral veins of the control group. RESULTS: Our results indicate a predominant thrombotic state as evidencedby activated coagulation markers and enhanced fibrinolysis insystemic circulation of ESRD patients. However the most novelfinding is the probable contribution of AVF on haemostatic activation,as proven by the statistically different and positively correlatedconcentrations of both coagulation, fibrinolysis, and fibrinolysisinhibitors in AVF when compared to the levels in peripheralvenous circulation. CONCLUSION: In addition to systemic derangements of haemostasis in ESRDpatients, AVF individually might have a substantial role inthe modulation of coagulation and fibrinolytic cascade.     

Surgical treatment of a left anterior descending artery to the main pulmonary artery fistula

We report a case of surgical treatment of a 58-year-old symptomatic patient with large coronary artery fistula, which drained from the left anterior descending artery into the main pulmonary artery (PA), and concomitant large patent foramen ovale. The surgery was performed through a median sternotomy with aortobicaval total cardiopulmonary bypass. The PA was incised. The fistula was identified 5 mm above the anterior leaflet of the pulmonary valve and was closed off using a prolene suture. Afterward, the atrium septum defect was closed with a Dacron patch via the standard right atrium access. There were no postoperative complications.     

冠状动脉旁路移植术后症状复发患者的旁路移植血管状态评估

目的总结冠状动脉旁路移植术后症状复发患者的临床特点,探讨并分析旁路移植血管造影检查结果.方法回顾性收集2008年1月至2018年12月间1136例冠状动脉旁路移植术后症状复发患者的临床资料.其中男868例,女268例;年龄(62.5±8.7)岁,≥65岁485例(42.7%).合并高血压852例(75.0%),高脂血症548例(48.2%),糖尿病524例(46.1%),有吸烟史713例(62.8%).结果患者旁路移植术后至症状复发(4.65±3.39)年.1073例(94.5%)表现为胸痛,146例(12.9%)旁路移植血管完全失功能,326例(28.7%)旁路移植血管完全通畅.共移植旁路血管3341根,其中失功能(狭窄、闭塞)1435(43.0%)根,263(25.5%)根为动脉旁路移植血管,1172(50.8%)根为静脉旁路移植血管.左乳内动脉旁路移植血管失功能率为22.8%(209/916),低于右乳内动脉、胃网膜右动脉、桡动脉和游离的乳内动脉.前降区失功能率(30.6%)远低于回旋区(52.7%)和右冠状动脉区(56.9%).596例(52.0%)接受经皮冠状动脉介入术再血管化治疗再发症状,其中526例(88.3%)在原位血管进行.结论冠状动脉旁路移植术后症状复发最常见为胸痛,症状复发患者的冠状动脉造影结果比较严重.再血管化治疗方式主要为PCI,原位血管是其主要手术部位.     

Off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction

Objective  Off-pump coronary artery bypass grafting (OPCAB) is known to preserve left ventricular function better than conventional coronary artery bypass grafting (CCAB). This study was carried out to investigate the safety, feasibility and efficacy of off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction. Methods  Three hundred and eighty eight consecutive patients with preoperative left ventricular ejection fraction ≤ 39% who underwent CABG between January 2001 through October 2007 were included in this retrospective study. Two hundred and eleven patients were operated by off-pump technique (group 1) and 178 patients were operated by on-pump technique (CCAB) (group 2). The postoperative outcomes were analyzed. Of these, 204 (52.57%) patients were diabetics, 355 (91.49%) patients had documented prior myocardial infarction, 316 (81.44%) patients were in canadian cardiovascular society(CCS) class III and 47 (12.11%) patients were in CCS class IV. Results  There was no significant difference in the number of grafts per patient between the two groups [group 1 3.02 ± 0.76 vs group 2 3.18 ± 0.72 (P=0.07) and the index of completeness of revascularization was comparable [1.08 ± 0.08) (OPCAB) vs 1.04 ± 0.06 (CCAB) (p=0.52)] The left internal thoracic artery was anastomosed to left anterior descending artery in 98% of patients. Operative mortality was 2.8% (6 deaths) following OPCAB and 3.93% (7 deaths) following CCAB (p=0746). Postoperative usage of IABP support was higher in CCAB group (12 patients vs 4 patients: P<0.03) and usage of moderate or higher doses of inotropic support was also higher in the conventional group (p<0.0006). More worsening of preexisting renal insufficiency was observed in CCAB group (p=0.01) and no significant difference in the incidence of atrial fibrillation was observed between the groups. Conclusions  Off-pump coronary artery bypass grafting is feasible and safe in patients with depressed left ventricular function and the postoperative morbidity was less in OPCAB group compared to on-pump group.     

非体外循环冠状动脉旁路移植术后低氧血症相关因素分析

目的分析非体外循环冠状动脉旁路移植术(Offpump coron aryartery bypass grafting,OPCABG)后低氧血症的影响因素。方法回顾性分析135例患者OPCABG术后并发低氧血症44例,对患者的年龄、性别、吸烟史、体质量、高血压、糖尿病、冠脉病变、术前心功能与低氧血症进行相关性分析。结果 CABG患者高龄、肥胖、长期大量吸烟及术前心功能底下与低氧血症有显著相关;性别、糖尿病、高血压、冠脉病变支数与CABG术后低氧血症发生率无明显相关性。结论 OPCAB术后低氧血症与多种因素有关,预防措施包括术前、术中、术后的各个阶段。     

Congenital arteriovenous fistula in the gluteal region —A report of five cases

Five cases of congenital arteriovenous fistula in the gluteal region have been encountered in our department in the past 20 years. In all cases, the fistulous masses were in the connective tissue between the gluteal muscles and well-localized. Preoperative angiography showed the feeding arteries to be the superior gluteal, the inferior gluteal, and/or the lateral femoral circumflex arteries, and all the arteriovenous fistulae were excised almost completely with success. In this report, we emphasize the importance of precise estimation of the feeding arteries on preoperative angiography and ligating them before excising the fistulous masses, to ensure safe surgical treatment.