Management of true aneurysms of hemodialysis access fistulas

Pasklinsky, Garri; Meisner, Robert J.; Labropoulos, Nicos; León, Luis R.; Gasparis, Antonios P.; Landau, David; Tassiopoulos, Apostolos K.; Pappas, Peter J.

doi:10.1016/j.jvs.2010.11.100

Cited by 95 publications

(125 citation statements)

References 10 publications

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“…Lastly, the histologic assessment confirmed the presence of intimal, medial, and adventitial layers. 8 Histologic confirmation was available in only 10 cases. We do not believe this was a limitation, because the gross appearance of a true aneurysm after surgical dissection was very distinctive.…”

Section: Discussionmentioning

confidence: 99%

“…12 Interposition bypass has been done using great saphenous vein, but this is limited by the size and quality of the vein. 8 Covered stent graft treatment for arteriovenous access aneurysms has been reported, but there are concerns regarding higher infectious complications. 13,14 We were reluctant to place stents in areas that would subsequently be cannulated due to concerns for stent fracture, thrombosis, and infection.…”

Section: Discussionmentioning

confidence: 99%

“…1 Several surgical techniques have been used to address aneurysmal AVFs. [5][6][7][8] Surgical aneurysmorrhaphy involves resection of a portion of the aneurysmal wall and primary closure using the remaining wall, thus preserving an autogenous AVF. Several authors have performed surgical aneurysmorrhaphy using a mechanical stapler.…”

mentioning

confidence: 99%

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Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Tumbaga

Aka

et al. 2015

Journal of Vascular Surgery

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Our experience with staple aneurysmorrhaphy shows that it is an effective, safe, and durable procedure to preserve a functioning autogenous AVF with complicated aneurysmal degeneration. Key principles are to reduce the vein to normal adjacent diameter and to provide healthy skin coverage. The remodeled AVF has a low aneurysm recurrence rate and maintains the beneficial properties of superior patency and low infection. It is important to aggressively monitor for and treat proximal outflow venous stenoses to prevent aneurysm recurrence. The surgery can be done safely under local anesthesia in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Tumbaga

Aka

et al. 2015

Journal of Vascular Surgery

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“…Among these complications, thrombosis is the most frequently encountered etiology for AVF dysfunction. It is one of the main causes of abandoning an aneurysmal AVF (13). …”

Section: Discussionmentioning

confidence: 99%

Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

Ahn

Choi

et al. 2015

Korean J Radiol

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ObjectiveTo evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm.Materials and MethodsSixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis.ResultsThe thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively.ConclusionThrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

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“…An alternative to autogenous repair is to use a synthetic graft. Studies have documented that these interposition grafts are successful in fistula salvage, and yield survival similar to the autogenous methods (10–13). For example, Georgiadis et al.…”

mentioning

confidence: 99%

Graftula: A Composite Access Consisting of a Graft Used to Repair a Dysfunctional Hemodialysis Fistula

Ramani¹,

Kallam²,

Zibari³

et al. 2012

Seminars in Dialysis

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Nonmaturing or dysfunctional hemodialysis fistulas are often repaired with interposition grafts placed either within the fistula (fistula-to-fistula configuration), or connected to another vein (fistula-to-vein configuration). The goal of this study was to compare the survival and usefulness of the composite accesses thus created, which we call "graftulas," with upperarm grafts. This was a retrospective study wherein we determined the survival and thrombosis rates of graftulas (n=24) and upper arm grafts (n=31) placed 1/1/07 through 12/31/09 and followed through 11/30/10. Graftulas resembled grafts as most (96%) were successfully cannulated in 65 ± 43 days. Survival of graftulas was also similar to grafts (58%, 47%, and 32% vs. 56%, 47%, and 39% at 1, 2, and 3 years respectively, p=0.60). However, graftulas had a lower thrombosis rate than grafts (0.5 vs. 1.2 per patient year, p=0.04), and in the fistula-to-fistula configuration, a 2-year thrombosis-free survival of 78%. Total survival of the access site (fistula+graftula) was 92%, 73%, and 42% at 1, 3, and 5 years, respectively. Graftulas possess certain beneficial properties of fistulas and grafts that allows for continued use of the original access site.

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Management of true aneurysms of hemodialysis access fistulas

Abstract: Although true aneurysms in patients with dialysis access are uncommon, significant complications may occur as a consequence of their presence. These complications can be treated and the fistulas can usually be salvaged.

Cited by 95 publications

References 10 publications

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

Graftula: A Composite Access Consisting of a Graft Used to Repair a Dysfunctional Hemodialysis Fistula

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