title: True Brachial Artery Aneurysm after Arteriovenous Fistula for Hemodialysis: Five Cases and Literature Review.
abstract: BACKGROUND
  The donor artery after a long-standing arteriovenous fistula (AVF) for hemodialysis usually evolves exceptionally toward a true aneurysmal degeneration (AD). The purpose of this article was to describe true brachial artery AD in end-stage renal disease patients after AVF creation, as well as its influencing factors and treatment strategies.
  
  
  METHODS
  We present a retrospective, observational, single-center study realized in Caen University Hospital's Vascular Surgery Department from May 1996 to November 2015. The inclusion criteria were true AD of the brachial artery after a vascular access for hemodialysis. A literature research, using the same criteria, was performed on the articles published between 1994 and 2015. The used databases included MEDLINE (via PubMed), EMBASE via OVID, Cochrane Library Database, and ResearchGate.
  
  
  RESULTS
  Our series includes 5 patients. Twenty-one articles were found in the literature: 17 case reports, 3 series, and 1 review. The same triggering factors for AD (high flow and immunosuppressive treatment) were found. The mean age at the time of AVF creation, first renal transplantation, and AD's diagnosis were respectively 26 (range 15-49), 29.2, and 48.6 years (range 37-76) in our series versus 34 (range 27-39), 40.4 (range 28-55), and 55.5 years (range 35-75) in cases found in the literature. The time spread after AVF creation and aneurysmal diagnosis was about 20.6 years (range 18-25) in our study versus 20.5 years (range 9-29) in the case reports. Our surgical attitude corresponds principally to that described in the literature. Nevertheless, we describe for the first time one case of arterial transposition to exclude the brachial aneurysm using superficial femoral artery.
  
  
  CONCLUSIONS
  Arterial aneurysm is a rare, but significant complication after a long-term creation of hemodialysis access. High flow and immunosuppression may accelerate this process. Young age of the patients may act as a benefic factor and delay the AD. Arterial transposition could be an option in the absence of any venous conduit, if anatomy does not permit the use of prosthetic grafts.
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Jihene
authors.initials: J
authors.lastname: Fendri
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France. Electronic address: palcaulaura@yahoo.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Palcau
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cameliere
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Coffin
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Felisaz
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Djelloul
authors.initials: D
authors.lastname: Gouicem
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Dufranc
authors.affiliation: Department of Vascular Medicine, CHU Caen, Caen, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Laneelle
authors.affiliation: Department of Vascular Surgery, CHU Caen, Caen, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005602:France; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents