Treatment of aneurysms of hemodialysis access arteriovenous fistulas

Karatepe, Celalettin; Yetim, Tülin Durgun

doi:10.5606/tgkdc.dergisi.2011.088

Cited by 13 publications

(11 citation statements)

References 13 publications

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“…In our study, six (20%) patients had aneurysmectomy with new fistula formation, and eleven (36.66%) patients had aneurysmectomy with interposition graft. Karatepe et al revealed that 25 out of 30 patients had aneurysmectomy with plication and arterio-venous anastomosis; three patients had aneurysmectomy and graft interposition, which is less used compared to our study 5 . Similar to our study, a recent study by Belli et al reported the use of interposition graft in 12 of 31 aneurysmal cases, while the remaining 14 patients underwent aneurysmectomy and primary suturing and 5 had ligation of fistula due to other factors 12 .…”

Section: Discussioncontrasting

confidence: 59%

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Arteriovenous Fistula Aneurysm

Al-Agha¹,

Alqaseer²,

Shehab³

2016

BMB

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Chronic renal failure patients need renal replacement therapy to sustain their lives. Renal replacement therapy could be either hemodialysis (HD) or peritoneal dialysis (PD). In hemodialysis, a vascular access is created to connect the patient to the dialysis machine; the access could be a central line, a native arterio-venous fistula (AVF) or a synthetic arteriovenous graft (AVG) 1 . AVF provides the best functional patency and the least complications 1 . AVF is the recommended vascular access in patients who need dialysis treatment 2 . Nevertheless, complications, such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon 3 .A recent study on regular hemodialysis patients revealed that AVF aneurysm formation is the most common complication 3 . Background: Arterio-venous fistula (AVF) provides the best functional patency for patients onregular hemodialysis (HD). Nevertheless, complications such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon. Objective: To evaluate the trends in AVF aneurysm formations, prophylaxis and treatment options. Design: A Retrospective, Descriptive Study. Setting: Hemodialysis Centers, Ministry of Health, Kingdom of Bahrain. Method: Two hundred and eleven patients on hemodialysis via arterio-venous fistula and arteriovenous graft were included in the study. Result: Two hundred and eleven patients were on hemodialysis via arterio-venous fistula and arterio-venous graft. Thirty (14.22%) patients developed arterio-venous fistula aneurysm. Sixteen (53.33%) were males, and the mean age was 57 years. Eleven (36.66%) patients had excision of the aneurysms with interposition graft. Six (20%) patients had excision of the aneurysms with new fistula formation. Six (20%) patients required a change of the cannula insertion site while the remaining 7 (23.33%) patients were waiting for their scheduled date of surgery. Conclusion: Aneurysm formation is the most common complication in post AVF patients on regular HD. AVF aneurysms are at high risk of rupture and fatal hemorrhage. Surgical treatments could safely be performed for high risk aneurysms. The most common cause of aneurysm formation is repeated punctures at the same site.

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Section: Discussioncontrasting

confidence: 59%

“…However, complications do occur. The most commonly reported complication is post AVF aneurysm formation [3][4][5] . AVF aneurysms are at high risk of rupture, which could lead to fatal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula Aneurysm

Al-Agha¹,

Alqaseer²,

Shehab³

2016

BMB

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“…In the presented case, the ulnar artery aneurysm (Figure 7) was resected without further reconstruction, as the angiographic evidence of the superficial artery ( Figure 5) provided adequate perfusion of the hand, as demonstrated by the Allen test and Doppler ultrasound. If left untreated, local compression, emboli, distal ischemia, or rupture can develop [19,27].…”

Section: Discussionmentioning

confidence: 99%

Aberrant Ulnar Artery and Ulnar Artery Thrombosis with Nerve Entrapment: A Case Report and Review of Literature

MS-IV¹,

RPAC²

2015

J Vasc Med Surg

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Ulnar artery aneurysms are quite rare discoveries, related to repetitive trauma, vasculitis, anatomic abnormalities, or infections. Typically caused by blunt injury to the ulnar artery and superficial palmar arch, arterial wall damage leads to the formation of an aneurysm. The sensory branch of the ulnar nerve becomes compressed, causing paraesthesia and weakness along the 4 th and 5 th digits, and resection is required. It is interesting to note, in this particular case, that a high origin and superficial ulnar artery coursed along the forearm and entered along the ulnar side of the hand. A diagnostic and therapeutic approach is necessary to relieve ulnar nerve entrapment. In addition, it is important to establish an early diagnosis prior to any surgical procedures in order to isolate and establish continuous flow to the compromised region. Further studies are required, however, to establish an evidenced-based approach to such anatomic variations with surgical repair.

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“…Reasons to repair an aneurysm were skin changes such as thinning or erosion, inflammation, pain, and thrombosis with flow impediment. If left untreated, local compression, emboli, distal ischemia, or rupture can develop [9,10]. The resected aneurysm (Figure 3) was sent for pathologic evaluation, which demonstrated wall thickening and abnormality of the vessel wall architecture due to thrombosis (Figure 4a and 4b).…”

Section: Discussionmentioning

confidence: 99%

Aberrant Ulnar Artery and Ulnar Artery Thrombosis with Nerve Entrapment: A Case Report

Nn¹

2015

J Surg Surgical Res

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Introduction: Vascular compromise causes hand pain, and physical examination requires to differentiate vascular causes from isolated ulnar nerve compression. Diagnostic studies visualize vascular abnormalities such as CT scans, MRA scans, and AV fistulograms. Ulnar artery aneurysms are quite rare discoveries, related to repetitive trauma, vasculitis, anatomic abnormalities, or infections. It is essential to repair any aneurysm when flow impediment causes significant symptoms. Blunt injury to the ulnar artery and superficial palmar arch damages the arterial wall and forms an aneurysm. The sensory branch of the ulnar nerve becomes compressed. Treatment here is to resect the thrombotic segment to relieve the compression. It is interesting to note, in this particular case, that a high origin and superficial ulnar artery had coursed along the forearm and entered along the ulnar side of the hand. The presence of such anatomic variations are essential in medical practice. Case presentation: A 73-year-old Haitian female was admitted to the hospital with complaints of numbness and weakness along the right forearm and wrist. According to the patient's daughter, she has experienced these symptoms for at least two years' duration after minimal trauma to her right hand. Upon physical examination of the right wrist, a 3-cm palpable, pulsatile ulnar mass was found. The Allen's test showed no significant abnormalities, but the Tinel's test and pinprick examination were diminished. An AV fistulogram was scheduled the same day and a repair followed soon after. IV contrast dye demonstrated an aneurysm of the ulnar artery, along with an adjacent superficial branch. The decision was made to resect the aneurysm and allow the superficial ulnar artery remain patent for continuous blood supply to the 4th and 5th digits of her right hand. She was discharged the same day and to follow up in the vascular clinic a week later. Conclusion: This particular case describes a couple important disciplines that establishes further insight about the human anatomy, pathophysiology and vascular surgical management. First, hypothenar hammer syndrome has been illustrated in a patient without any history of vasculitis, infections, or congenital anatomic abnormalities. A diagnostic and therapeutic approach is necessary to relieve ulnar nerve entrapment. Second, this particular patient underwent a simple repair but it was found that an aberrant ulnar artery was discovered, which coursed adjacent and superficial to the aneurysm. It is important to establish an early diagnosis prior to any surgical procedures. Intraoperatively, proper identification to isolate and establish a continuous blood flow is essential. Knowledge of such variations allows for improved care in the fields of radiology, angiography, surgery and the medical sciences. very little English, but her daughter translated. As per her daughter, the patient complained of numbness, pain and weakness along the right arm, forearm, and wrist. She had visited her home in Haiti two years ago, and believ...

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Treatment of aneurysms of hemodialysis access arteriovenous fistulas

Cited by 13 publications

References 13 publications

Arteriovenous Fistula Aneurysm

Arteriovenous Fistula Aneurysm

Aberrant Ulnar Artery and Ulnar Artery Thrombosis with Nerve Entrapment: A Case Report and Review of Literature

Aberrant Ulnar Artery and Ulnar Artery Thrombosis with Nerve Entrapment: A Case Report

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