The aneurysmal arteriovenous fistula – morphological study and assessment of clinical implications. A pilot study

Watson, Kenneth R.; Gallagher, Maeve; Ross, Rose; Severn, Alison; Nagy, J; Cochrane, Lindy; Griffiths, Gareth

doi:10.1177/1708538114557069

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…In our study, as in other studies, skin thinning and ulceration were the most common reason for surgical intervention [7][8][9][10]. Cutaneous atrophy may lead to ulceration and associated catastrophic haemorrhage which requiring emergency ligation of the fistula [11]. By the reason of life threatening bleeding due to rupture, we had to ligature 4 (57.1%) of the fistulas that we had performed emergency surgery.…”

Section: Discussionsupporting

confidence: 64%

Surgical interventions for autogenous arteriovenous fistula aneurysms in hemodialysis patients

Özsin

Sanrı

Kahraman

et al. 2018

The European Research Journal

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Objectives. The aim of this study was to emphasize the importance of surgical intervention perfotmed before development of arteriovenous fistula (AVF) aneurysm complications. Methods. The patients were categorized into two groups: Patients undergoing elective surgery for autogenous AVF aneurysm were defined as elective group (Group 1), whereas those who underwent emergency surgery due to ruptured aneurysmal fistulas were defined as emergency group (Group 2). All elective cases were evaluated by doppler ultrasonography before surgery. All patients had temporary hemodialysis catheters. In the patients with salvaged fistulas, the fistulas was rested for 1 week. A new fistula was created in patients with not salvaged fistula. Results. A total of 31 patients (54.8% male, mean age: 41.2 ± 14.7 years) were in Group 1 and 7 patients (57.1% male, mean age: 53 ± 9.4 years) were in Group 2. Significant difference was observed between two groups in terms of fistula preservation. Salvaged fistulas were significantly higher in the Group 1 than Group 2 (p = 0.003). In Kaplan-Meier curves, cumulative primary AVF patency rates at 1, 3 and 6 months were 96.3%, 81.5%, and 77.8% in Group 1 and 66.7%, 66.7%, and 66.7% in Group 2, respectively (log-rank; p = 0.536). Conclusions. Consultation of these cases with a cardiovascular surgeon before they reach the rupture stage is an important condition for both the patency of the fistula and the vital risk of the patient.

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Section: Discussionsupporting

confidence: 64%

Surgical interventions for autogenous arteriovenous fistula aneurysms in hemodialysis patients

Özsin

Sanrı

Kahraman

et al. 2018

The European Research Journal

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“…Rajput et al . also use relative size to the adjacent AVF and defined an aneurysm as a focal dilatation of the outflow vein diameter greater than two times the normal calibre of the adjacent normal fistula vein segment [ 7 ] although Watson and colleagues suggest size alone may not be useful in predicting behaviour [ 8 ].…”

Section: Definitionsmentioning

confidence: 99%

“…Sonographic assessment should include transverse and longitudinal measurements and assessment of flow and thrombus In addition, the inflow and outflow vessels should be assessed. Wall characteristics such as thickness and infection may also be possible [ 8 , 23 ].…”

Section: Managementmentioning

confidence: 99%

Aneurysms and pseudoaneurysms in dialysis access

Mudoni¹,

Cornacchiari²,

Gallieni

et al. 2015

Clin Kidney J

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Aneurysms are a common and often difficult complication seen with arteriovenous vascular access for haemodialysis. The purpose of this narrative review is to define and describe the scale of the problem and suggested therapeutic strategies. A narrative review of the published literature illustrated by individual cases is presented with the aim of summarising the relevant literature. The definitions of aneurysm are inconsistent throughout the literature and therefore systematic review is impossible. They vary from qualitative descriptions to quantitative definitions using absolute size, relative size and also size plus characteristics. The incidence and aetiology are also ill defined but separation into true aneurysms and false, or pseudoaneurysms may be helpful in planning treatment, which may be conservative, surgical or radiological. The lack of useful definitions and classification along with the multitude of management strategies proposed make firm evidence based conclusions difficult to draw. Further robust well designed studies are required to define best practice for this common problem.

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“…11,12 No universally accepted definition of what constitutes an aneurysm exists, with some studies defining an aneurysm on the basis of relative size, for example 2 to 3 times the diameter of the adjacent native vein, or absolute size, a venous segment measuring greater than 6 mm or a dilation of the AVF greater than 20 mm. 14,18,19 This confounds precise quantification of aneurysm incidence which has been reported to range widely from 5% to 60%. 13 The clinical indications for aneurysm intervention include pain, prolonged bleeding, decreased dialysis clearance or high cardiac output failure.…”

Section: Discussionmentioning

confidence: 99%

Arterial diameter following arteriovenous fistula creation predicts aneurysm progression

et al. 2021

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Objective: To investigate the relationship between arteriovenous fistula (AVF) arterial diameter (AD) and AVF aneurysm development and progression. Methods: This study identified all patients who underwent fistulograms which demonstrated AVF aneurysms meeting criteria and requiring surgical intervention between 01/01/2014 and 7/30/2016. Patient demographics were collected and AVF dimensions were measured on fistulograms. A control group with nonaneurysmal AVFs who had undergone serial fistulograms between 2013 and 2016 were identified and identical datasets collected. Statistical analysis was performed with STATA 14.0 using student’s t-test, Chi square tests and linear regression. Results: 45 eligible patients were identified in the AVF aneurysm study group and 24 in the control group, with the mean age of AVF creation being older in the control group (61.8 vs 53 years, p = 0.03). The mean interval between AVF creation and first fistulogram in the study group was 1464 ± 282 days, compared to an interval of 263 ± 101 days in the control group ( p = 0.003). The AD on the first fistulogram in those study group patients with aneurysms evident on first fistulogram was greater than in the control group (6.5±1.8 mm vs 5.0 ± 1.8 mm, p = 0.003). The AD on first fistulogram of the study group predicted maximum aneurysm diameter on last fistulogram ( r = 0.6, p = 0.03) as well as the interval between first fistulogram and surgical revision ( r = −0.33, p = 0.03). Conclusion: AVF aneurysms are a later complication in access natural history and AD may help to predict their progression.

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The aneurysmal arteriovenous fistula – morphological study and assessment of clinical implications. A pilot study

Cited by 8 publications

References 18 publications

Surgical interventions for autogenous arteriovenous fistula aneurysms in hemodialysis patients

Surgical interventions for autogenous arteriovenous fistula aneurysms in hemodialysis patients

Aneurysms and pseudoaneurysms in dialysis access

Arterial diameter following arteriovenous fistula creation predicts aneurysm progression

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