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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2015 Giugno;22(2):65-9
Management of arteriovenous fistula-related true aneurysms: when and how?
Özülkü M. 1, Saba T. 1, Duman E. 2, Kal Ö. 3, Yildirim E. 2
1 Department of Cardiovascular Surgery, Medical Faculty, Baskent University, Bağlıca, Ankara, Turkey;
2 Department of Radiology, Medical Faculty, Baskent University, Bağlıca, Ankara, Turkey;
3 Medical Faculty, Medical Faculty, Baskent University, Bağlıca, Ankara, Turkey
AIM: This study examined the effect of revision surgery in patients who present solely with a complicated arteriovenous (AV) fistula aneurysm.
METHODS: Thirty-three patients underwent surgery for a true venous aneurysm related to an AV fistula. An aneurysm was considered to be present when a vein was dilated to more than three times of its original size. Symptoms and characteristics of aneurysm, treatment method, and duration of follow-up period were recorded.
RESULTS: There was a true aneurysm due to radio-cephalic AV fistula in 11 patients, brachio-cephalic AV fistula in 20 patients, and brachio-basilic AV fistula in 2 patients. Twenty-seven patients underwent aneurysmorrhaphy (primary repair) operation. AV fistula was removed due to arm edema and pain in 2 patients in whom the central vein was totally occluded. The aneurysm was partially removed and venous continuity was preserved by placing a PTFE graft in 4 patients.
CONCLUSION: AV fistula aneurysms can be primarily repaired without disrupting the continuity AV fistula vein and requiring a new hemodialysis route. Early repair of AV fistula aneurysms with aneurysmorrhaphy before additional complications (infection, thrombosis) develop is important with regard to survival of AV fistula. It was beneficial that nearly all patients (27 patients) undergoing aneurysmorrhaphy continued hemodialysis program from the same AV fistula vein and required no catheter placement.