Aneurysmal degeneration of the donor artery after vascular access

Objective This retrospective study analyzed the characteristics, potential risks, and therapeutic options of true aneurysms of the donor artery in arteriovenous fistulas (AVFs) for dialysis access. Methods We retrospectively collected data of patients with aneurysmal degeneration (AD) after AVF creation from surgeons who were members of the French Society for Vascular Access, treated from January 2006 to May 2011. The study excluded patients with pseudoaneurysms. Patient demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up were recorded. Results Seven men and three women (mean age, 38.1 ± 5.3 years) were identified with AD (mean diameter, 44.5; range, 24-80 mm) Mean duration of access was 83.6 ± 48.8 months. Diagnosis of AD was at 117.5 ± 53.8 months after access creation. The initial access was radiocephalic, six; ulnobasilic, one; brachiocephalic, two; and brachiobasilic, one. Three patients had two successive accesses: one brachioaxillary polytetrafluoroethylene (PTFE) graft and two proximalizations of a failed radiocephalic AVF. Symptoms were pain and swelling, four; pain related to total thrombosis without signs of ischemia, two; median nerve compression, two; pain related to contained rupture, one; and subacute ischemia due to embolic occlusion of both radial and interosseous arteries, one. AD location was brachial, seven; axillary, one; radial, one; and ulnar, one. Eight patients underwent surgical aneurysm excision associated with interposition bypass using great saphenous vein, two; basilic vein, one; PTFE, three; Dacron, one; and allograft, one. Two patients needed secondary PTFE bypass because of progression of AD to the inflow artery and dilatation of the venous bypass. With a mean follow-up of 20.3 ± 17 months, all bypasses but one remained patent. Conclusions AD is a rare but significant complication of vascular access. Surgical correction should be discussed in most cases due to potential complications. After resection, the choice of reconstructive conduit is not straightforward.