title: Partial aneurysmectomy is effective in managing aneurysm-associated complications of arteriovenous fistulae for hemodialysis: case series and literature review.
abstract: Fistula aneurysms are commonly seen and usually do not affect fistula function for hemodialysis. However, these aneurysms are associated with complications that increase the risk of fistula bleeding and loss. The common feature of these complications is that the diseased tissues usually affect a localized area of an aneurysm. Accordingly, we developed a targeted intervention "partial aneurysmectomy" in which only the diseased area was resected. In this report, we sought to examine the outcomes of partial aneurysmectomies performed in 36 cases for the following indications: active bleeding (14%), skin scab plus fistula defect in imminent danger of bleeding (33%), skin necrosis and erosion (28%), and thin-walled aneurysm in danger of rupture (25%). Postoperatively, all patients continued hemodialysis using their fistulae. During 2-18-month follow-up, all fistulae but one were functional and required no intervention on the repaired areas. At 6 months, the aneurysm primary patency, fistula primary patency, and fistula-assisted primary patency rates were 97%, 56%, and 97%, respectively. In conclusion, partial aneurysmectomy is a simple and effective intervention for managing aneurysm-associated complications and preserving fistula function. Owing to its advantages over other interventions, we recommend partial aneurysmectomy as first-line choice for managing aneurysm-associated complications.
authors.affiliation: University of Arizona, Phoenix, AZ, USA.
authors.forename: Ammar
authors.initials: A
authors.lastname: Almehmi
authors.forename: Shouwen
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000209:etiology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000379:methods*