Giant arteriovenous fistula pseudoaneurysm resection: case report

Abstract

Introduction: It has been estimated that pseudoaneurysms appear in 4% of patients with autologous arteriovenous fistulas, mainly in the venous segment of those accesses with more than five years of evolution caused by rupture of the vessel wall and the consequent extravasation of blood to adjacent tissues. Objective: Describe a case with a resection giant arteriovenous fistula pseudoaneurysm and a review of literature. Case report: A 51-year-old male patient with a history of chronic kidney disease receiving renal replacement therapy through autologous arteriovenous fistula in the left thoracic limb and later kidney transplant from a cadaveric donor. His condition began with occasional mild pain at the level of the arm and forearm of the left thoracic limb, which progressed in intensity, partially limiting mobility and adding edema from the antecubital fold yo the distal point. He reported two isolated episodes of hypothermia and paresthesias that resolved spontaneously. A venous Doppler ultrasound was performed, finding the path of the fistula arteriovenous vein causing dilatation of the basilic vein with a thrombus inside. It was decided to dismantle the arteriovenous fistula, finding a venous path of the basilic vein of approximately 8 cm in diameter with a thrombosed upper segment. At the 1-month follow-up, the wound was found to have healed well and the patient was reported to be asymptomatic. Conclusion: In patients with large, complex pseudoaneurysms, or with failed endovascular interventions, surgical management is the best option.