• Vol. 40 No. 3, 136–139
  • 15 March 2011

Surgical Remodelling of Haemodialysis Fistula Aneurysms



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Introduction: One complication of autogenous arteriovenous fistula (AVF) for haemodialysis is the formation of a venous aneurysm.

Clinical Picture:The clinical picture is typically an expanding aneurysm leading to skin atrophy and ulceration with the risk of rupture and infection. Aneurysm also reduces the potential cannulation area.

Treatment: The cases described here used a surgical ‘remodelling’ technique involving complete skeletonisation of the venous aneurysm, reduction of lumen diameter and retention of vein wall using a Hegar dilatator to remodel a new fistula.

Outcome: Six patients were treated using this method and the arterior venous shunt (AVS) was used for haemodialysis the following day. No recurrent aneurysm developed.

Conclusion: Remodelling of aneurysmal AVF is an effective and low-risk option for managing this kind of complication, allowing direct access for haemodialysis.

The Kidney Disease Outcomes Quality Initiative (DOQI) guideline 3 recommends autogenous radiocephalic and brachiocephalic arteriovenous fistula (AVF) as the first and second choices of treatment for primary permanent vascular access in patients with kidney failure. A native arteriovenous fistula is now widely accepted as the vascular access of choice of treatment in patients undergoing haemodialysis due to its low complication and high patency rates. However, even though superior to catheters and grafts, AVF complications, mainly stenosis and thrombosis, are the leading cause of morbidity in the haemodialysis population. Furthermore, one late possible complication is aneurysmatic dilatation of the arterialised vein bed. This not only reduces the available sites for cannulation, it can also lead to thrombosis and/or rupture with massive haemorrhage. Expansion of the venous aneurysm can lead to skin atrophy and ulceration with the risks of infection and rupture. Aneurysmatic dilatations can also seriously reduce the patient’s quality of life. It is necessary however to distinguish these aneurysma from the pseudoaneurysms that can form after cannulation using synthetic grafts.

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