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Home > Vascular Annual Meeting > PP21. Reduction and Reconstruction of Aneurysmal...

PP21. Reduction and Reconstruction of Aneurysmal Arteriovenous Fistulas: Mid-Term Results of a Novel Approach to Salvage Autogenous Dialysis Access

Karen Woo1, Patrick R. Cook1, Robert J. Hye2, Timothy G. Canty2
1Scripps Green Hospital, La Jolla, CA; 2Kaiser Permanente Medical Group, San Diego, CA

OBJECTIVES: Over the last decade, K-DOQI guidelines have increasingly emphasized the importance of autogenous arteriovenous fistulas (AVF) for dialysis access. A complication of AVF is aneurysmal dilatation with a subset developing massive diffuse aneurysm. Treatment of massive aneurysmal AVF generally involves either ligation or resection with use of prosthetic interposition. In order to maintain an all-autogenous access, we developed a procedure to treat massive aneurysmal AVF in which the lumenal diameter is reduced, excess length is resected, and the new reconstructed AVF is retunneled for continued use.

METHODS: Over a four-year period, the reduction/revision procedure was performed on 18 patients with an AVF diameter of 4-7 cm. Indications for operation were thrombosis, skin breakdown, infection, bleeding, and/or poor flow. Revision was performed by resecting redundant length, reducing diameter, and then reconstructing the fistula.

RESULTS: Patients ranged in age from 25 to 83 with a mean of 48. There were 12 men and 6 women. The mean and median follow-up was 20 months. The mean and median primary patency was 17 and 14 months, respectively. The mean and median secondary patency was 19 and 16.5 months, respectively. Two patients died, one AVF thrombosed, and two were ligated secondary to infection. One fistula developed a stenosis that was treated with angioplasty. There are no recurrent aneurysms to date.

CONCLUSIONS: Surgical resection of excess length, reduction of lumenal diameter, and reconstruction is a viable option for the treatment of complicated massive diffusely aneurysmal AVF. This technique offers the ability to maintain the benefits of an all autogenous dialysis access while conserving future dialysis sites.

AUTHOR DISCLOSURES: K. Woo, None; P.R. Cook, None; R.J. Hye, None; T.G. Canty, None.

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