title: A modified stapling technique for the repair of an aneurysmal autogenous arteriovenous fistula.
abstract: OBJECTIVE
  An alternative surgical technique for the repair an aneurysmatic arteriovenous fistula (AVF) using a staple remodeling operation has been developed and the results are reported.
  
  
  METHODS
  All patients presenting with an aneurysmatic autogenous AVF of the upper extremities between January 2012 and December 2013 were included in the analysis. The AVF was approached laterally along the entire aneurysm and then remodeled using a stapler on the lateral side of the vein wall. All stenotic segments were excised. Follow-up included a clinical visit and echo color Doppler of the fistula and was performed 7, 15, and 30 days after the intervention and every 6 months thereafter.
  
  
  RESULTS
  We treated 14 patients (nine men [64.3%]) with a median age of 65 years (interquartile range [IQR], 62.5-69 years). Elective interventions were performed in 12 patients (85.7%), and two underwent emergency treatment because of postcannulation bleeding. Technical success was achieved in all cases. The mean duration of the intervention was 75 minutes (IQR, 61.15-83.45 minutes). No in-hospital deaths or major morbidities were observed. Median hospitalization time was 24 hours (IQR, 25-38 hours). Postoperative puncture was performed after a median delay of 12.5 hours (IQR, 12-17 hours). No patient was lost during the follow-up, which was a median of 16.5 months (IQR, 14-23 months). Primary functional patency was 12 of 14 (85.7%). Pseudoaneurysm, bleeding, hematoma, or infection was not observed.
  
  
  CONCLUSIONS
  In our experience, the stapling technique proved to be easy, fast, and safe. Early follow-up outcomes showed excellent primary patency and confirmed the effectiveness of the technique because local complications were never observed.
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Tozzi
authors.affiliation: Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; General Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Franchin
authors.affiliation: Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; General Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ietto
authors.affiliation: Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; General Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Soldini
authors.affiliation: Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; General Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Chiappa
authors.affiliation: Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; General Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Carcano
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy; Center for Research on Organ Transplantation, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Castelli
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*