SURGICAL METHOD TO GIANT ANEURYSM IN ARTERIOVENOUS FISTULA FOR HEMODIALYSIS

Purpose: Artreriovenous fistula creation is a frequently used method in order to achieve an easier access for hemodialysis, hence increase the quality of life in the patients having chronic renal insufficiency. Complications related to arteriovenous fistulae are encountered much more in the recent years, because of expanding population of this patient group. The most frequently seen complication in the late period is aneurysm formation.

Methods: The study includes 18 patients who were operated on between the dates of June 1997 and June 2003, in the cardiovascular surgical departments of both Alsancak State Hospital and Dokuz Eylul Medical Faculty, with the indication of giant aneurysms exceeding 8 cm, which had been developed on the arteriovenous fistulae, created for the purpose of hemodialysis access. Eleven of the cases (61.1%) were male and the mean age was 43.1. Except for the one patient which were operated for spontaneous aneurysm rupture in the emergency conditions, color duplex ultrasonographic examination of the upper extremity were performed in all patients in the preoperative period, and the surgical method included aneurysm resection, afterwards rebuilding the arterial continuity.

Results: Any of the complications such as infection, ischemic extremity loss, neurologic sequela and mortaity did not take place. Color duplex ultrasonographic examinations that were made in the late period of 6 months were all normal. The mean follow-up period of the patients after the aneurysm resection was 29.1 months (7-50 months). Any additional vascular complication could not be observed during the follow-up.

Conclusion: Aneurysm formation, which is a complication of arteriovenous fistula, is a pathologic process seen in the late period due to the usage of the fistula, and early surgical intervention is the recommended choice of therapy because of the risk of spontaneous rupture. (Turkish J Vasc Surg 2003;12(2): 11-15)