Aneurysmorraphy as an actual method of treatment of true aneurysms by arteriovenous fistulas

One of the complications of autogenous arteriovenous fistula (AVF) used for hemodialysis is the development of a true arteriovenous vein (VA) aneurysm. The consequences of aneurysm formation – including infection – skin changes at the aneurysm site, bleeding, rupture, thrombosis, and impaired blood flow – can result in inadequate hemodialysis. Among these complications, the most critical indication requiring urgent intervention is life-threatening bleeding. The standard treatment for a massive AVF aneurysm often involves ligation or resection with prosthetic interposition. Whenever possible, the first surgical intervention should aim to preserve natural access ideally without prosthetic grafting, creation of new vascular anastomoses or fistula ligation. Partial aneurysmectomy with or without reductive venoplasty, has been proposed as a method of managing this complication while maintaining fully autogenic access. The article describes a simple surgical technique for correcting a double aneurysmally altered AVF in a patient 7 years after the creation of an AVF mid-forearm. The procedure did not require postoperative central catheter implantation. Given the risk of partial fistula thrombosis, suppuration, and potentially fatal hemorrhage due to rupture, reconstructive surgery was performed. The operation consisted of partial excision of of the diseased venous segments (aneurysmorrhaphy), while preserving AVF function. The advantages of aneurysmorraphy include technical simplicity, safety under local anesthesia, effective removal of diseased tissues; and preservation of AVF function. This approach maintains inherent benefits of an autogenous AVF, while conserving vascular access site for future use. Aneurysmorraphy – also referred as reductive aneurysmoplasty, partial aneurysmectomy, or restoration/recalibration – represents a valuable surgical option, particularly for megaphystules. It emphasized preservation of native access while allowing flexibility in surgical technique tailoring individual case.

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