Pseudoaneurysms in dialysis access – Outcomes of surgical repair

Abstract

Context: This study documents the outcomes of pure surgical attempt to salvage pseudoaneurysms (PSAs) in dialysis access. Considering that the long-term outcomes of surgical salvage are nearly the same as that of stent-graft use, it is possible if sufficient evidence accumulates to suggest that a surgical salvage of PSA can be considered as an equally safe option. Objectives: The literature on pure surgical repair of PSA is sparse. At a reported 6-month patency rate of 75%, open surgical salvage offers a reasonable option for salvaging a vascular access complicated by PSA formation. We report our results of attempted surgical salvage of PSA and an overview of the available literature on the use of endograft and surgical repair of PSA. Methods: This was a retrospective review of all patients presenting with PSA between January 2009 and November 2018. The methods of salvage include primary repair or excision with interposition of graft, the primary outcome being to obtain a functional access. Results: During the above period, of the 1462 fistulae created, 32 (2.1%) presented with PSA. The average time from the access creation to the presentation was 24.26 months. The overall technical salvage rate was 31% (n = 10), with the salvaged fistulae having a 3 patency rate of 60%, the mean follow-up being 14.5 months. Conclusion: About 31% of fistulae with PSA could be salvaged with a 3-month patency of 60%. Surgical salvage therefore appears to be a durable option for PSA in patients undergoing hemodialysis.