Autologous Surgical Reconstruction for True Venous Hemodialysis access Aneurysms–-Techniques and Results

Sigala, Fragiska; Kontis, Elissaios; Saßen, Regine; Mickley, V.

doi:10.5301/jva.5000224

Cited by 12 publications

(6 citation statements)

References 25 publications

(28 reference statements)

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“…The age of the aneurysmal fistula was between 521 days and 2,521 days. This is consistent with other studies of AVA where the average age of the AVF was between 16.5 and 72.8 months when treatment was initiated (range 12-136 months) (8, 26–31).…”

Section: Incidence and Natural Historysupporting

confidence: 92%

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Aneurysms in Vascular Access: State of the Art and Future Developments

et al. 2017

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A master class was held at the Vascular Access at Charing Cross (VA@CX2017) conference in April 2017 with invited experts and active audience participation to discuss arteriovenous (AV) vascular access aneurysms, a serious and common complication of vascular access (VA). The natural history of aneurysms in VA is poorly defined, and although classifications exist they are not uniformly applied in studies or clinical practice. True and pseudo aneurysms of AV access occur. Whilst an AV fistula by definition is an abnormal dilatation of a blood vessel, an agreed definition of 18 mm, or 3 times accepted maturation diameter, is proposed. The mechanism of aneurysmal dilatation is unknown but appears to be a combination of excessive external remodeling, wall changes due to injury, and obstruction of outflow. Diagnosis of AV aneurysms is based on physical examination and ultrasound. Venography and cross-sectional imaging may assist and be required for the investigation of outflow stenosis. Treatment of pseudo aneurysms and true aneurysms of VA (AVA) is not evidence-based, but relies on clinical experience and available facilities. In many AVA, a conservative approach with surveillance is suitable, although intervals and modalities are unclear. Avoidance of rupture is imperative and preemptive treatment should aim for access preservation, ideally with avoidance of prosthetic materials. Different techniques of aneurysmorrhaphy are described with good results in published series. Although endovascular approaches and stenting are described with good short-term results, issues with cannulation of stented areas occur and, while possible, this is not recommended, and long-term access revision is recommended.

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Section: Incidence and Natural Historysupporting

confidence: 92%

“…In more extensive aneurysms, simple bypass or interposition using an autologous or prosthetic graft can be used and the aneurysmal segment excluded (8, 31, 55, 56).…”

Section: Managementmentioning

confidence: 99%

Aneurysms in Vascular Access: State of the Art and Future Developments

et al. 2017

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“…Also, autologous surgical reconstruction is feasible in the majority of AVF aneurysms. It preserves fistula function and keeps the advantages of an autogenous access [207]. The rupture of such aneurysms in high-flow fistulas can lead to exsanguination and death ( Figure 14).…”

Section: Arteriovenous Fistulas Complicationsmentioning

confidence: 99%

Vascular Access and New Trends

Grapsa¹,

Pantelias²

2015

Updates in Hemodialysis

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“…Surgical interventions for pseudoaneurysms include ligation, end-to-end AVF, excision and repair, endovascular procedures, and embolization. However, no "gold standard" exists for the management of pseudoaneurysms [2][3][4][5][6]. We present our experiences with the surgical management of pseudoaneurysms and report the efficacy of a dual-plane approach using a Dufourmentel skin flap with a purse-string suture for vessel wall reinforcement.…”

Section: Introductionmentioning

confidence: 99%

A dual-plane approach for surgical treatment of pseudoaneurysm with arteriovenous fistula in hemodialysis patients

et al. 2021

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Background We report the efficacy of a dual-plane approach using a Dufourmentel skin flap with a purse-string suture of the de-epithelized dermis to manage pseudoaneurysm at the vascular access site for hemodialysis.Methods A retrospective analysis was conducted of 61 patients from 2013 to 2018 with pseudoaneurysms at the arteriovenous fistula or graft who were treated with rhomboid excision, vessel repair with a purse-string suture, and a full-thickness Dufourmentel skin flap. The success rate was defined as the probability of complete wound closure and intact vascular access patency without infection or other complications.Results The success rate was 93.4% at 6 months postoperatively. Complications included newly occurring pseudoaneurysms (n=2), wound dehiscence (n=1) and bleeding (n=1). There were no complications such as stenosis or thrombosis from the procedure.Conclusions A dual-plane approach using a Dufourmentel skin flap with a purse-string suture for vessel repair was shown to be a favorable option for managing stable, small (diameter <2 cm) pseudoaneurysms without infection, rapid expansion, or patency issues of the vascular access.

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Autologous Surgical Reconstruction for True Venous Hemodialysis access Aneurysms–-Techniques and Results

Abstract: Autologous surgical reconstruction is feasible in the majority of AVF aneurysms. It preserves fistula function and--in contrast to graft interposition and endovascular repair--keeps the advantages of an autogenous access: low complication and high patency rates.

Cited by 12 publications

References 25 publications

Aneurysms in Vascular Access: State of the Art and Future Developments

Aneurysms in Vascular Access: State of the Art and Future Developments

Vascular Access and New Trends

A dual-plane approach for surgical treatment of pseudoaneurysm with arteriovenous fistula in hemodialysis patients

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