title: Reinforced aneurysmorrhaphy for true aneurysmal haemodialysis vascular access.
abstract: OBJECTIVE
  In 2008, a new technique of reinforced aneurysmorrhaphy with a polyester mesh tube for salvaging true aneurysmal arteriovenous (AV) haemodialysis access was described by us. In this study, the long-term patency and complication rates associated with this procedure were analysed, and the effect of reinforced aneurysmorrhaphy on high-flow vascular access was assessed.
  
  
  METHODS
  This was a retrospective non-randomised study with prospectively collected data performed at a single centre. Patients with true aneurysmal haemodialysis AV access who underwent aneurysmorrhaphy with external mesh prosthesis between March 2007 and October 2012 were included. Clinical assessment and duplex ultrasound were performed preoperatively, 1, 3, and 12 months postoperatively, and annually thereafter.
  
  
  RESULTS
  Data from 62 patients (median age 60 years, range 28-81 years; 63% men) were analysed. The commonest indication was high-flow vascular access associated with the risk of high output cardiac failure (24 patients, 39%). The mean follow-up time was 14.66 ± 12.80 months. Primary patency rates at 6 and 12 months were 86% and 79% respectively. Assisted primary patency rates at 6 and 12 months were 89% and 80% respectively. In 23 patients (96%) operated on for high-flow vascular access, decreased vascular access flow was observed after the procedure. The average flow reduction after aneurysmorrhaphy was 2,197 mL/minute. Postoperative bleeding and infection necessitating surgical revision occurred in three (4.8%) and three (4.8%) patients respectively.
  
  
  CONCLUSIONS
  Reinforced aneurysmorrhaphy with an external mesh prosthesis is an effective method for treating true aneurysmal haemodialysis AV access, with excellent long-term patency and minimal complications due to infection.
authors: Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Electronic address: slavomir.rokosny@ikem.cz.
authors: S
authors: S
authors: Rokošný
authors: Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Surgery, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic.
authors: P
authors: P
authors: Baláž
authors: Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic.
authors: P
authors: P
authors: Wohlfahrt
authors: Radiodiagnostic and Interventional Radiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors: D
authors: D
authors: Palouš
authors: Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors: L
authors: L
authors: Janoušek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Aneurysm; Aneurysmorrhaphy; Arteriovenous access; External mesh prosthesis; High-flow access