title: Aneurysmal degeneration of the inflow artery after arteriovenous access for hemodialysis.
abstract: OBJECTIVE
  After arteriovenous fistula creation, the arterial flow increase can lead to aneurysmal degeneration, even increased after fistula ligation or renal transplant immunosuppression. The aim of this study is to describe the therapeutic options and outcomes of true aneurysms of the inflow artery after arteriovenous fistula for hemodialysis.
  
  
  METHODS
  Prospectively collected data of patients with true aneurysmal degeneration of the inflow artery after fistula creation (excluding pseudoaneuryms, anastomotic or infected aneurysms, or surgical complications), surgically repaired between January 2010 and February 2014 (cohort study) have been included. Patient demographics and access characteristics, symptoms, treatment, and follow-up have been reviewed.
  
  
  RESULTS
  12 patients (75% men, median age 63 years) were treated for aneurysmal degeneration of the axillary (1), brachial (6), or radial (5) artery. They had had a previous distal arteriovenous fistula (7 radiocephalic, 3 brachiocephalic, 2 brachiobasilic) created 15.6 years before (range 9.9-28.5) and the majority of them were currently ligated or thrombosed. Most patients were symptomatic (pain [6], distal embolization [1]). They were treated by means of a bypass (using the cephalic [3], basilic [4], or saphenous vein [2]), direct ligature (2), or excision with end-to-end reconstruction (1). No major complications or ischemic symptoms occurred before discharge. After a median follow-up of 8.6 months (3.1-36.5), one patient needed re-operation for new proximal brachial aneurysmal degeneration, and another presented with an asymptomatic post-traumatic thrombosis of the proximal axillary artery and brachial bypass. No other complications, bypass dilatation or ischemic symptoms occurred during follow-up.
  
  
  CONCLUSIONS
  Inflow artery aneurysmal degeneration can occur after long-term arteriovenous access. Surgical treatment by autogenous bypass exclusion in most cases (or ligation or end-to-end reconstructions in selected cases) is a safe and effective option.
authors.affiliation: Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain. Electronic address: gasparmestres@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Mestres
authors.affiliation: Vascular Access Unit, Department of Nephrology, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Fontsere
authors.affiliation: Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Yugueros
authors.affiliation: Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Tarazona
authors.affiliation: Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Ortiz
authors.affiliation: Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Riambau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000601:surgery*; D000792:Angiography / Q000379:methods; D001158:Arteries / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008026:Ligation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods
keywords: Aneurysm; Arteriovenous fistula; Arteriovenous shunt; Renal dialysis; Vascular grafting