[Problems in the therapy of central arterial ectasias and elongations in long-lasting arteriovenous fistulas].

Acquired arteriovenous fistulas should be surgically cured as soon as possible after the diagnosis. In all the patients we treated, the arteriovenous fistula had existed for quite a long time, i.e. up to 26 years. These arteriovenous fistulas were surgically closed by the separation-method, the resection of the vessels and vascular reconstruction, or by the transvenous technique. - Arteriovenous fistulas, which have been in existence for quite a long time, result in cardiac dilatation, which can be cured after closure of the arteriovenous fistula. Furthermore, there can be pathologic changes of the vein and artery wall: chronic venous insufficiency and arterial ectasia can result. - After closure of the arteriovenous fistula our patients no longer complained of venous reflux disturbances. Even after closure of the arteriovenous fistula, an arterial ectasia is not reversible. The reasons for this are discussed. Symptoms, which occur after the closure of an arteriovenous fistula, which had existed for a long period and had produced a severe arterial ectasia, are looked upon as an autonomous disease. During the progress of this disease many complications can occur, even the rupture of the ectatic artery. The question is therefore discussed, whether it is justified to resect the ectatic arterial segment together with the arteriovenous fistula and to implant an alloplastic vascular graft in its place during the initial operation.