Aneurysm Excision With Arteriovenous Anastomosis Proximalization for Dialysis Fistula Aneurysm Treatment

Introduction: Dialysis fistula aneurysms are common complications, which require surgical revision in selective cases. The results of aneurysm excision with arteriovenous anastomosis proximalization for the treatment of dialysis fistula aneurysms have been described below. Methods: Patients qualified for the reconstruction of a dialysis fistula aneurysm underwent a duplex ultrasound examination. The diameter, length of the aneurysm, relations with the artery, thrombus presence and blood flow were determined. In the case of favorable anatomical conditions, we performed aneurysm excision with arteriovenous anastomosis proximalization as the procedure of choice. Patients, dialysis access, operative data and the results obtained during a median follow-up of 41 months were then analyzed. Findings: Since 2012, we have performed 20 aneurysm excision combined with primary anastomosis as dialysis fistula aneurysm treatment. In 18 patients, aneurysm excision was combined with simple re-anastomosis in the more proximal arterial segment. In 2 autogenous radio-cephalic forearm direct fistulas the aneurysm excision was combined with switching anastomosis type from side-to-end to end-to-end. The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 94.7% and 82.4%, respectively. No early complications were noted. In 7 patients (35%) we observed late complications, which required reintervention or led to access failure. Dialysis fistula thrombosis as an indication for treatment was a significant risk factor for late re-occlusion. Discussion: A simple primary reconstruction by arteriovenous anastomosis proximalization and aneurysm excision for the surgical correction of dialysis fistula aneurysms has potential benefits compared to established methods—aneurysmorraphy and aneurysm excision with a vascular prosthesis bypass. The obtained data showed the efficiency, safety and excellent long-term results of this procedure.