Arterial Aneurysmal Degeneration With Venous Varicosity Following Ligation of an Arteriovenous Fistula in a Kidney Transplant Recipient

Abstract

Late occurrence of arterial aneurysms following ligation of a hemodialysis arteriovenous fistula (AVF) is rare. Here, we report the case of 51-year-old male patient with an AVF in which arterial aneurysms developed. The patient had undergone left arm radiocephalic (RC) AVF creation for hemodialysis in 2000. He had received a living related donor kidney transplantation from his father in the same year. His RC AVF was ligated in 2009. However, his arm continued to gradually grow in size even after ligation and he visited a hospital for acute pain and erythema around the left elbow in 2017. Since his renal allograft function had been deteriorating, duplex ultrasonography was performed. It revealed 2 giant aneurysms in the distal brachial artery and proximal radial artery with diameters of 3.0 and 2.8 cm, respectively. The superficial veins of the left upper arm showed varicosity and had multifocal thrombi. Microfistula between the artery and vein was revealed by contrast-enhanced ultrasonography and the contrast agent microbubbles flowed from the artery toward the superficial veins. The aneurysms were resected and the arteries were reconstructed with great saphenous vein. There were no perioperative complications and the patient was discharged on postoperative day 3. No complications in the arm or bypass conduit have occurred at 6 months after the surgery.

True Brachial Artery Aneurysm in Patients with Previous Arterio-Venous Fistula Ligation and Immunosuppressant Therapy for Renal Transplantation: Case Report and Literature Review

“…Fifty-six BAA cases were reported in the literature [ 2 , 4 , 5 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. The mean age of patients was 50.94 yo (ranging between 26 and 77 yo).…”

Vascular Reconstruction of a Brachial Artery Aneurysm Proximally to an Arteriovenous Malformation

“…11,12 Our patient did not have any systemic symptoms or additional aneurysms, although we speculate that the distal AVM created hemodynamic stress that caused the brachial artery to become ectatic, similar to the altered flow dynamics that accompany prenidal aneurysms in the cerebral vasculature and upstream of dialysis fistulas. 13,14 The alterations in flow dynamics within a AVM or arteriovenous fistula has been shown to cause an "angiopathy" in animal models which might predispose to aneurysm formation. The precise mechanism for aneurysm formation in the setting of AVMs remains unclear but likely includes genetic, hostspecific, and flow-related phenomena.…”

Peripheral embolism as first and only clinical symptom of a true aneurysmal degeneration of the radial artery after ligation of a radiocephalic fistula

“…It can occur in long-term arteriovenous accesses and is not always prevented by ligation or thrombosis of the fistula. 4–6 In contrast to its classical presentation with pain as main symptom, we hereby present a patient with peripheral embolism as first and only symptom, leading to the diagnosis of a true aneurysmal degeneration of the complete left radial artery 5 years after radiocephalic fistula ligation. Because of the high risk of ischemic complications, we will discuss our treatment preference for a platelet antiaggregant combined with anticoagulation therapy rather than a surgical bypass which is considered as the standard treatment.…”