Emergency brachial artery ligation for ruptured infected pseudoaneurysm of haemodialysis access is a possible option

Abstract

Background: For patients with end-stage renal disease, a good vascular access is essential for chronic haemodialysis. Surgically created access arteriovenous fistula for haemodialysis is associated with multiple complications, and ruptured pseudoaneurysm being the most life threatening and dreaded of all. The management of this complication warrants emergency procedure, although timely diagnosis and arteriovenous fistula salvage has been emphasised. In this study, we describe the surgical technique and outcomes of ligation of the proximal arteriovenous fistula as a plausible alternative and life-saving procedure. Method and Results: This is a retrospective study performed between January 2011 and December 2016. A total of 588 native arteriovenous fistula–related surgeries were performed, of which 18 patients (3.06%) developed delayed complication of infected pseudoaneurysm and rupture. All presented to the emergency care with life-threatening bleeding. We describe the surgical technique as a life-saving measure to this fatal complication. Conclusion: Proximal arteriovenous fistula has higher incidence of aneurysmal complications than distal ones. Ligation of the brachial artery which was a ‘grey zone’ of unpredictable prognosis has yielded good results and can be safely performed in desperate situations with low complication rates.

Rupture infected pseudoaneurysm on brachiocephalic AV-fistula: emergency and definitive management

“…8 In the presence of infection, it leads to rupture and fatal hemorrhage. 2 In our case, bleeding at the surgical site of the AV fistula suddenly occurred without any history of previous trauma. On physical examination at the AVF site, the patient's wound appeared swollen and wet, accompanied by necrotic tissue and pus.…”

“…2, 8 The option to use an endovascular technique is contraindicated in the presence of infection. 2 In this case, open vascular reconstruction surgery was performed to salvage fistula access to hemodialysis. Unfortunately, the patient's cephalic vein tissue was completely damaged, then the goal of surgery was to improve the function of the brachial artery.…”

Tecnologia educacional para orientação de idosos nos cuidados com a fístula arteriovenosa

“…Referente ao rompimento da FAV, situação temida por muitos pacientes devido ao risco de morte, recomenda-se manter a compressão no local do sangramento e procurar o serviço de emergência imediatamente para ligadura da FAV (12) .…”