Emre KUBAT, Celal Selcuk UNAL, Emre GÖK, Aydin KESKİN

Surgical Approaches to Symptomatic Arteriovenous Fistula Aneurysms: a Single-Center Experience

Arteriovenous fistulas (AVFs) created for hemodialysis accesses are prone to aneurysmal degeneration. Arteriovenous fistula aneurysms may lead to pain, aesthetic problems, infection, bleeding, and fistula thrombosis. The aim of this study is to report our surgical approaches and outcomes of AVF aneurysms. Medical records of a total of 21 patients (9 males, 12 females) with an AVF aneurysm who underwent surgery at Karabuk Training and Research Hospital, Department of Cardiovascular Surgery between January 2013 and March 2015 were retrospectively analyzed. The mean age was 59.7±13.5 years. Aneurysmectomy was performed on eight patients, while partial aneurysmectomy and polytetrafluoroethylene graft interposition were carried out in four patients. Three patients underwent aneurysmorrhaphy, whereas six patients underwent thrombectomy + aneurysmorrhaphy to the aneurysmatic segment. All patients were discharged without any event at the postoperative second day. They were scheduled for follow-up visits and assessed by Doppler ultrasound. Currently, surgical repair is the gold standard in the treatment of AVF aneurysms. Based on our experience, we recommend surgical interventions for selected patients to maintain AVF continuation.

PDF

___

1. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176-247.

2. Registry of the Nephrology, Dialysis and Transplantation in Turkey. Registry 2013.

Omega CRO. İstanbul, Turkey: Turkish Society of Nephrology; 2014. 3. Cronenwett JL, Johnston KW. Rutherford's Vascular Surgery. Vol. 2, 7th edition. Philadelphia: Saunders Elsevier; 2010.

4. Twardowski ZJ, Kubara H. Different sites versus constant sites of needle insertion into arteriovenous fistulas for treatment by repeated dialysis. Dial Transplant 1979;8:978-80.

5. Verhallen AM, Kooistra MP, van Jaarsveld BC. Cannulating in haemodialysis: ropeladder or buttonhole technique? Nephrol Dial Transplant. 2007;22(9):2601-4.

6. Mestres G, Fontsere N, Yugueros X, Tarazona M, Ortiz I, Riambau V. Aneurysmal degeneration of the inflow artery after arteriovenous access for hemodialysis. Eur J Vasc Endovasc Surg. 2014;48(5):592-6.

7. Eugster T, Wigger P, Bölter S, Bock A, Hodel K, Stierli P. Brachial artery dilatation after arteriovenous fistulae in patients after renal transplantation: a 10-year follow-up with ultrasound scan. J Vasc Surg. 2003;37(3):564-7.

8. Padberg FT Jr, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg. 2008;48(5 Suppl):55S-80S.

9. Karatepe C, Yetim TD. Treatment of aneurysms of hemodialysis Access arteriovenous fistulas. Turkish J Thorac Cardiovasc Surg. 2011;19(4):566-9.

10. Georgiadis GS, Lazarides MK, Panagoutsos SA, Kantartzi KM, Lambidis CD, Staramos DN, Vargemezis VA. Surgical revision of complicated false and true vascular accessrelated aneurysms. J Vasc Surg. 2008;47(6):1284-91.

11. Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998;9(5):869-76.

12. Valenti D, Mistry H, Stephenson MA. Novel classification system for autogenous arteriovenous fistula aneurysms in renal access patients. Vasc Endovascular Surg. 2014;48(7-8):491-6.

13. Shah AS, Valdes J, Charlton-Ouw KM, Chen Z, Coogan SM, Amer HM, Estrera AL, Safi HJ, Azizzadeh A. Endovascular treatment of hemodialysis Access pseudoaneurysms. J Vasc Surg. 2012;55(4):1058-62.

14. Hedin U, Engström J, Roy J. Endovascular treatment of true and false aneurysms in hemodialysis access. J Cardiovasc Surg (Torino). 2015; 56(4):599-605.