Characteristics, Management, and Outcomes of Surgically Treated Arteriovenous Fistula Aneurysm in Patients on Regular Hemodialysis

Ann Vasc Surg. 2017 May:41:46-55. doi: 10.1016/j.avsg.2016.08.046. Epub 2017 Feb 24.

Abstract

Background: To investigate the clinical characteristics, surgical interventions, and outcomes of arteriovenous fistula (AVF) aneurysms, we retrospectively analyzed patients on regular hemodialysis (HD).

Methods: We conducted a cohort study of all patients with HD access who presented with AVF aneurysms and underwent operative procedures over a 11-year period. Patients' demographics, comorbidities, vascular access characteristics, management of aneurysms, complications, and outcomes were analyzed.

Results: Of the 700 end-stage renal failure patients, 530 patients were maintained on HD (130 through PermCath and 400 through AV access in terms of AVF and arteriovenous graft). We identified 129 patients who developed AV aneurysms, and 40 of them required surgical interventions (24 men and 16 women) with a mean age of 58 ± 14.6 years. The 40 patients who developed AVF aneurysms underwent 43 surgical interventions. The majority of aneurysms were presented with thinning and ulceration (82.5%) of the overlying skin. Thirty-four patients had true aneurysms and 6 had pseudoaneurysms. The aneurysmal AVF comprised 26 brachiocephalic fistulas, 9 radiocephalic fistulas, 3 brachial artery grafts, 1 ulnar-basilic fistula, and 1 Fem-Fem graft at presentation. Patients were treated mainly with ligation (13; 32.5%), excision and repair with graft interposition (15; 37.5%) or vein interposition (11; 27.5%), and end-to-end AVF (1; 2.5%). The median follow-up postsurgery duration was 53 months (range 1-192) and the median duration from fistula creation to the surgical intervention was 52 months (range 4-182). On follow-up, 34 patients continued on HD, while 5 underwent renal transplantation and 1 shifted to peritoneal dialysis. The overall all-cause mortality rate was 37.5% and the leading causes of mortality were sepsis/pneumonia (60%), myocardial infarction, and heart failure (40%).

Conclusions: In HD patients, the rate of AVF aneurysmal formation is high with a significant rate of morbidity and mortality. Therefore, timely and appropriate evaluation and surgical intervention are crucial.

MeSH terms

  • Adult
  • Aged
  • Aneurysm / diagnostic imaging
  • Aneurysm / etiology
  • Aneurysm / mortality
  • Aneurysm / surgery*
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Arteriovenous Shunt, Surgical / mortality
  • Databases, Factual
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Qatar
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / mortality
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Upper Extremity / blood supply*