title: GIA-Aneurysmorrhaphy and Dermal Detachment: A Novel Technique to Repair Arteriovenous Fistula Aneurysms.
abstract: This report describes a simplified technique for management of aneurysmal arteriovenous fistulas along with results of initial clinical experience in 12 patients. Various techniques have been described which seek to repair the arteriovenous fistula and lengthen its duration of use. Here, we introduce the GIA-aneurysmorrhaphy and dermal detachment (GADD) procedure, a novel technique which requires minimal dissection to decompress tension on the overlying skin. Transverse incisions were made proximally and distally to the aneurysmal segment, which was then bluntly dissected along its length on either side. A GIA stapler is then fired along the longitudinal axis, narrowing the lumen of the fistula and separating the aneurysm from the skin. After the operation, the arteriovenous fistulae were used continuously until death (1 patient for 12 months), until thrombosis (1 patient for 13 months), or continue to be in use (9 patients, mean patency 18 months). One patient underwent conversion to open aneurysmorrhaphy due to intraoperative fistula occlusion. Five patients resumed hemodialysis immediately, while the remaining resumed hemodialysis within 3 months. The most common complication was cellulitis (3 patients). The GADD procedure as described in this report offers an effective and low-risk option for the management of venous aneurysms with threatened skin in hemodialysis patients.
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA. Electronic address: jason.s.chang@kp.org.
authors.forename: Jason
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA.
authors.forename: Jateen
authors.initials: J
authors.lastname: Prema
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA.
authors.forename: Rose
authors.initials: R
authors.lastname: Pedersen
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA.
authors.forename: Max
authors.initials: M
authors.lastname: Liebl
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA.
authors.forename: Kaushal
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, CA.
authors.forename: Mark
authors.initials: M
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D004210:Dissection; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis; D012086:Reoperation; D017792:Surgical Stapling; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*