Management of symptomatic arterial and venous aneurysms in hemodialysis patients related to arteriovenous fistulas

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COD: 10_2868 Categorie: ,

Tevfik Avci, Hakan Yabanog˘lu, Gökhan Moray, Mehmet Haberal

Ann. Ital. Chir., 2018 89, 3: 247-254

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AIM: Our aim in this study is to present the management of the symptomatic aneurysms that are related to AVF.
MATERIAL AND METHODS: Between January 2011 and January 2017, 50 patients who were operated due to symptomatic
AVF aneurysms were evaluated. Forty-four (88%) patients’ fistulas were closed for symptomatic venous aneurysm.
In 6 (12%) patients true brachial artery aneurysm were present and a segmental artery resection with its repair was
performed.
RESULTS: The most common symptomatic aneurysm was seen on the brachiocephalic fistula (n=32, 64%). The symptoms
of the patients were; aneurysm thrombosis (n=15, 30%), steal syndrome (n=9, 18%), rupture/massive bleeding (n=7,
14%), infection (n=7, 14%), skin necrosis (n=5, 10%), venous hypertension (n=4, 8%) and high output cardiac failure
(n=1, 2%). Nine (18%) patients had two or more symptoms. While the mean duration of dialysis of patients who
underwent venous aneurysmectomy was 6.9 ± 4.2 years, patients who underwent arterial aneurysmectomy and brachial
artery repair was 11.7 ± 3.6 years (p = 0.012).
DISCUSSION: Arterial aneurysm is a rare complication of vascular access. Although it causes serious symptoms including
those of related such as thrombosis, ischemia, nerve compression, the most important complication is aneurysm rupture.
Therefore, preoperative evaluation and appropriate surgical interventions will prevent morbidities that may arise.
CONCLUSION: The choice of a treatment modality in patients with a symptomatic arteriovenous fistula aneurysms is to
maintain the continuity of the arteriovenous fistula but when acute bleeding occurs in an unstable patient, ligation of
fistula should be considered.

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