Modified Staple Aneurysmorrhaphy for Treating Arteriovenous Fistula–Related Venous Aneurysms

Autogenous arteriovenous fistulas (AVFs) are the preferred access for hemodialysis. AVF occasionally develop venous aneurysms, and we report a modified staple aneurysmorrhaphy technique for treatment. Briefly, the lateral wall of the venous aneurysm is dissected and a longitudinal staple resection performed. Adjunct procedures include inflow banding and outflow venous angioplasty with possible stenting. In this initial experience, 20 aneurysms were resected in 17 patients. The average AVF age at time of repair was 5.8 years. Sixteen of 17 AVF remained patent, and there were no recurrences or mortalities. One patient had a loss of thrill intraoperatively after stapling and was successfully treated with cephalic vein embolectomy. All AVF were cannulated for dialysis immediately following the procedure. The average follow-up period was 12.5 months. Given the benefits of uninterrupted fistula use and avoidance of temporary catheter placement, this technique is a promising therapy for arteriovenous fistula related venous aneurysms.