Salvage Treatment for Venous Aneurysm Complicating Vascular Access Arteriovenous Fistula: Use of an Exoprosthesis to Reinforce the Vein after Aneurysmorrhaphy
Received 28 August 2009; accepted 10 January 2010. published online 04 March 2010.
Abstract
Objectives
We report a new salvage technique for treating venous aneurysms (VAs) complicating vascular access arteriovenous fistula (AVF) using externally reinforced venous aneurysmorrhaphy.
Design
A retrospective study over a 20-month period from a single centre.
Patients
Patients presenting to the vascular surgery department, Bordeaux University Hospital for revision of a vascular access AVF were included.
Methods
Reinforced venous aneurysmorraphy consisted in removal of redundant vessel wall followed by reinforcement using an external prosthetic graft. Patency, diameter and flow were assessed by duplex ultrasound at 1, 6 and 12 months after salvage.
Results
Thirty-eight eligible patients were identified. Five were excluded because VA was associated with central vein stenosis; the remaining 33 underwent salvage. Indications were rapidly expanding or painful VA in seven cases; VA with frequent bleeding or damaged overlying skin in eight; VA in close relation to a stenosis in two; and VA associated with high-flow rate in 16. Cannulation was attempted after 30 days. Mean follow-up time was 12 S.D. 5 months (range: 4–22). Two repaired AVFs failed. Primary 1-year patency was 93%. No aneurysm or infection occurred. Reduction of high flow was successful in 12 of 16 patients. The remaining four required re-operation.
Conclusions
Reinforced venous aneurysmorrhaphy is effective in controlling venous dilation and achieving patency. Reduction of high-flow rates was not always achieved. Further study is needed to evaluate long-term efficacy of this treatment.
dDepartment of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
Corresponding author. Service de Chirurgie Vasculaire, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France. Tel.: +33 (0) 556795524; fax: +33 (0) 556796105.
ABSTRACT