title: Autologous surgical reconstruction for true venous hemodialysis access aneurysms--techniques and results.
abstract: OBJECTIVE
  Due to their relatively low complication rates autogenous arteriovenous fistulas (AVFs) are the preferred access for hemodialysis. In long-standing AVF, however, aneurysmatic degeneration of the fistula vein can develop. Several treatment options have been published. We evaluated our experience with autologous surgical reconstruction in patients with AVF aneurysms in order to assess complication and patency rates.
  
  
  METHODS
  Demographics and comorbidities of all patients operated on for true AVF aneurysms in our institution, during a 7-year period, were reviewed. Access function and surgical outcomes were evaluated with pre- and postoperative Doppler ultrasonography. Patient survival, primary and secondary access patency rates are presented.
  
  
  RESULTS
  From April 2006 through March 2013, 31 patients presented with access-associated upper extremity venous aneurysms. The mean time from AVF creation to aneurysm formation was 4.9±3.6 years. The most frequent indication for surgery was aneurysm-associated stenosis (n=16) followed by high flow (n=9), complete thrombosis (n=3) and uncontrolled bleeding (n=3). All patients had autologous reconstructions: 5 resections with end-to-end anastomosis and 26 aneurysmorrhaphies. Overall patient survival at 1 and 2 years was 89% and 84%, respectively. The primary (secondary) patency rates at 6 mo, 1 and 2 years were 87%, 81% and 81% (96%, 96% and 90%), respectively.
  
  
  CONCLUSIONS
  Autologous surgical reconstruction is feasible in the majority of AVF aneurysms. It preserves fistula function and--in contrast to graft interposition and endovascular repair--keeps the advantages of an autogenous access: low complication and high patency rates.
authors.affiliation: 1 Department of Vascular Surgery, Clinical Center Mittelbaden, Community Hospital Rastatt, Rastatt - Germany.
authors.forename: Fragiska
authors.initials: F
authors.lastname: Sigala
authors.forename: Elissaios
authors.initials: E
authors.lastname: Kontis
authors.forename: Regine
authors.initials: R
authors.lastname: Saßen
authors.forename: Volker
authors.initials: V
authors.lastname: Mickley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000601:surgery