title: A hybrid approach to salvage a failing long-standing autogenous aneurysmal fistula in a hemodialysis patient.
abstract: Very few studies have addressed the repair of autogenous and prosthetic-related false arteriovenous access (AVA) aneurysms in hemodialysis patients. Surgical management of complicated AVA-related aneurysms remains the gold standard method although covered stents have recently been introduced for the exclusion of such aneurysms, offering a minimally invasive therapy. In this paper, we describe a combination of open and endovascular repair for treating an anastomotic and a puncture-site aneurysm to salvage a failing long-standing autogenous radial-cephalic fistula in the wrist. Resection of the anastomotic aneurysm and reconstruction of the anastomosis proximally was initially performed. Via the first cm of the anastomosis, a Fluency® stent graft (SG) was inserted and it successfully excluded the mid-outflow vein false aneurysm. Such hybrid therapies may be the future of AVA revisions and this trend should not be overlooked by nephrologists and vascular surgeons.
authors.affiliation: Department of Vascular Surgery, Demokritus University of Thrace, Peripheral General Hospital of Alexandroupolis, Alexandroupolis, Greece. ggeorgia@med.duth.gr
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
authors.forename: Evagelos
authors.initials: E
authors.lastname: Nikolopoulos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papanas
authors.forename: Efthimia
authors.initials: E
authors.lastname: Mourvati
authors.forename: Stelios
authors.initials: S
authors.lastname: Panagoutsos
authors.forename: Miltos K
authors.initials: MK
authors.lastname: Lazarides
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D006435:Renal Dialysis; D012086:Reoperation; D016879:Salvage Therapy; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014953:Wrist / Q000098:blood supply*