Surgical Treatment Modalities for Complicated Aneurysms and Pseudoaneurysms of Arteriovenous Fistulas

Abstract

Purpose This study was designed to determine the clinical presentation, characteristics, and management of aneurysm/pseudoaneurysm formation (APF) in dialysis access fistulas. Methods The treatment methods and outcomes of 31 patients who underwent surgery for APF in dialysis access fistulas were retrospectively reviewed over a 9-year period. Results We performed 1558 operations for arteriovenous fistulas (AVFs) between 2000 and 2009 at our centre. Of the 1558 operations, 35 were carried out for APFs (2.2%) on 31 patients. Thirty of these operations were restorative. Twenty-two (71%) of these patients had their original access done elsewhere, and all corrective surgeries were performed at our hospital. Approximately 52% of the subjects were female, with a mean age of 45.7 ± 17 years. The mean duration of end-stage renal disease was 70.2 ± 51.5 months. The mean number of AVFs per patient was 2.2 ± 1.5. Synthetic grafts were used in five patients (16.1%). Most of the procedures were left-sided (67.7%) and brachial-cephalic fistulas (48.3%). Among 31 complications, 22 were arterial/venous aneurysms (71%) and nine were pseudoaneurysms (29%). Fourteen patients (46.6%) were treated by excision of the aneurysm and primary suture repair. The post-intervention primary patencies for all revised APFs were 68%, 56%, and 52% at 1, 6, and 12 months, respectively. Dysfunction of AVF (16.1%) and bleeding (12.9%) were the most encountered complications after aneurysmectomy. Conclusion Reformative operations should be considered in cases of urgency and irresponsiveness to endovascular surgery rather than closing the fistulas directly, as it prolongs the duration of AVF patency.