Surgical Treatment of Arteriovenous Fistula Aneuryms Seen in End Stage Renal Failure Patients by Aneurysmorrhaphy Method

Abstract

Background: In this study we investigated the approach to the aneurysms that develop in arteriovenous fistulas (AVF) performed in end stage renal failure (ESRF) patients and the efficacy and reliability of aneurysmorrhaphy as a surgical treatment method. Methods: Of the 100 patients with ESRF who underwent AVF operations in the Cardiovascular Surgery Department of Van Yuksek Ihtisas Hospital between January 2006 and January 2008, 15 patients (10 males, 5 females; mean age 36.5 +/- 24 years; range 29 to 64 years) in whom aneurysms developed were retrospectively analyzed. All patients were receiving ESRF treatment and hemodialysis (HD). Patients were followed for AVF localizations, functionality using aneurysmorrhaphy as a treatment modality for aneurysms over 4 cm in diameter. Results: The arteriovenous fistula localizations of 15 patients who developed aneurysms in their AVFs were right radial AVF in two (14%), right high AVF in one (6%), right brachial AVF in three (20%), left radial AVF in one (6%), left high AVF in three (20%), and left brachial AVF in five patients (34%). The mean fistula flow was 768 450 ml/min. All patients who developed aneurysms underwent aneurysmorrhaphy surgery. All patients were discharged within the first 48 hours. There was no infection, hematoma, ischemia, or neurological damage postoperatively. Fifteen AVFs were treated with aneurysmorrhaphy and followed up for 24 months. Conclusion: Aneurysms developed significantly more at the brachial level compared to the forearm. The forearm should be preferred for AVF operations considering the risk of aneurysm development. The AVFs with aneurysms can be effectively treated by aneurysmorrhaphy without jeopardizing the functionality of the fistulas.