Surgical Management of Giant Aneurysms Complicating Arteriovenous Fistulae

Abstract

The creation of an arteriovenous fistula (AVF) is frequently used to achieve easier access for haemodialysis in patients with chronic renal insufficiency. The most frequent late complication of AVFs is aneurysm formation, which carries the risk of spontaneous rupture. This study reports on 18 patients with giant aneurysms that developed on antebrachial AVFs who were operated on over a period of 6 years. Colour duplex ultrasonographic examination of the upper extremity was performed in all but one patient in the preoperative period. Surgical management included resection of the aneurysm and re-establishment of arterial continuity. There were no complications such as infection, ischaemic extremity loss, neurological sequelae or mortality. Colour duplex ultrasonographic examinations after 6 months were all normal. The mean follow-up period was 29.1 months (range 7-50 months). There were no additional vascular complications observed during follow-up. Early surgical intervention is the recommended treatment of choice for giant aneurysm complicating antebrachial AVF.

Midterm results of a novel technique to salvage autogenous dialysis access in aneurysmal arteriovenous fistulas

“…For localized aneurysms, resection with re-establishment of venous continuity has also been described. 11 This technique, however, is not applicable to the patient population described in this series.…”

Surgical revision of complicated false and true vascular access–related aneurysms

“…Surprisingly, there is no report in the literature on the effect of revision surgery in patients who present purely with complicated true or false AVA-related aneurysms. Only Karabay et al 42 have reported on purely surgical management of giant true aneurysms complicating antebrachial arteriovenous fistulas, but they did not mention the postintervention patency rates.…”

Treatment of aneurysms of hemodialysis access arteriovenous fistulas

“…[13] The surgical treatment of choice can either be closure of the fistula with ligation or preserving the continuity of the fistula by partial resection of the aneurysm sac. [14,15] It is an effective method for the elimination of the aneurysm, and the risk of bleeding during surgery is less with this method than with other methods. However, it has a disadvantage in that the fistula cannot be used again.…”

“…[17] Furthermore, early intervention was reported to be important since the risk of spontaneous rupture is a life-threatening complication. [15,18] In our cases, we operated on the aneurysm in the early period before the development of any complications. Therefore, we think that it is more efficient to do plication along with partial resection of aneurysm.…”