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

Abstract

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 sympto- matic 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 fai- lure (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.