Arteriovenous Fistula Aneurysm Research Articles

Surgical interventions for arteriovenous fistula aneurysms: Our single-center experience

Surgical interventions for arteriovenous fistula aneurysms: Our single-center experience

Brachial artery thrombosis due to a giant, stented arteriovenous fistula aneurysm in a renal transplant patient

Brachial artery thrombosis due to a giant, stented arteriovenous fistula aneurysm in a renal transplant patient

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

To investigate the clinical characteristics, surgical interventions, and outcomes of arteriovenous fistula (AVF) aneurysms, we retrospectively analyzed patients on regular hemodialysis (HD). 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. Of the 700 end-stage renal failure patients, 530 patients were maintained on HD (130through 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±14.6years. 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 53months (range 1-192) andthemedian duration from fistula creation to the surgical intervention was 52months (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 leadingcauses of mortality were sepsis/pneumonia (60%), myocardial infarction, and heart failure (40%). 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.

IP141. Extracellular Matrix Is a Durable Alternative Repair Material for Salvage of Autologous Arteriovenous Fistula Aneurysms

Arteriovenous fistula aneurysm (AVFA) formation is a complication of dialysis access. We report our experience with extracellular matrix (ECM) as a conduit for AVFA repair. Between October 2013 and February 2016, we conducted a prospective study of CorMatrix ECM for AVFA repair. All patients had an intraoperative fistulogram and treatment of concomitant central venous lesions when present. We excised the AVFA and the overlying skin in an elliptical fashion and used an ECM for repair. Patients were divided into two groups based on the use of an ECM patch vs an ECM tubularized interposition graft. A staged approach was used to treat patients with multiple AVFA. Repaired segments were cleared for cannulation after 6 weeks. A total of 27 patients underwent 37 AVFA repairs using ECM. Nine patients (33%) with multiple AVFA underwent staged repairs. Twelve patients (44%) underwent simultaneous treatment of central vein lesions. Treated sites included radiocephalic (3), brachiobasilic (2), and brachiocephalic (32) AVFA. Tube grafts were used in 20 procedures (54%) for fusiform aneurysms, and patch repairs were performed in 17 procedures (46%) for saccular aneurysms. All patients had hemodialysis at an alternative location within the repaired AVF without the need for catheter placement. At a mean follow-up time of 10.7 months after repair, 6 complications were identified (16%). Complications included 2 thrombosis, both in patients with known refractory central venous stenosis treated with previous angioplasty (2) and stenting (1); aneurysm recurrence at ECM repair site (1); skin erosion above ECM site (1); and severe bleeding at ECM repair site (2). Four complications (11%) were directly attributable to ECM repair sites. Both patients with thrombosed repairs and one patient with severe bleeding required new access placement (8%). ECM patch and tube graft repairs of AVFA results in a high rate of dialysis access site salvage. Follow-up complication rates are low with this technique. There is no difference in the patency rate or complications of the patients who received a patch vs a tube graft. Use of prosthetic grafts and bridging dialysis catheters were eliminated. Recurrent skin breakdown can lead to ECM infection, graft breakdown, and bleeding.

GIA-Aneurysmorrhaphy and Dermal Detachment: A Novel Technique to Repair Arteriovenous Fistula Aneurysms

This report describes a simplified technique for management of aneurysmal arteriovenous fistulas along with results of initial clinical experience in 12 patients. Various techniques have been described which seek to repair the arteriovenous fistula and lengthen its duration of use. Here, we introduce the GIA-aneurysmorrhaphy and dermal detachment (GADD) procedure, a novel technique which requires minimal dissection to decompress tension on the overlying skin. Transverse incisions were made proximally and distally to the aneurysmal segment, which was then bluntly dissected along its length on either side. A GIA stapler is then fired along the longitudinal axis, narrowing the lumen of the fistula and separating the aneurysm from the skin. After the operation, the arteriovenous fistulae were used continuously until death (1 patient for 12months), until thrombosis (1 patient for 13months), or continue to be in use (9 patients, mean patency 18months). One patient underwent conversion to open aneurysmorrhaphy due to intraoperative fistula occlusion. Five patients resumed hemodialysis immediately, while the remaining resumed hemodialysis within 3months. The most common complication was cellulitis (3 patients). The GADD procedure as described in this report offers an effective and low-risk option for the management of venous aneurysms with threatened skin in hemodialysis patients.

Surgical Approaches to Symptomatic Arteriovenous Fistula Aneurysms: a Single-Center Experience

Arteriovenous fistulas (AVFs) created for hemodialysis accesses are prone to aneurysmal degeneration. Arteriovenous fistula aneurysms may lead to pain, aesthetic problems, infection, bleeding, and fistula thrombosis. The aim of this study is to report our surgical approaches and outcomes of AVF aneurysms. Medical records of a total of 21 patients (9 males, 12 females) with an AVF aneurysm who underwent surgery at Karabuk Training and Research Hospital, Department of Cardiovascular Surgery between January 2013 and March 2015 were retrospectively analyzed. The mean age was 59.7±13.5 years. Aneurysmectomy was performed on eight patients, while partial aneurysmectomy and polytetrafluoroethylene graft interposition were carried out in four patients. Three patients underwent aneurysmorrhaphy, whereas six patients underwent thrombectomy + aneurysmorrhaphy to the aneurysmatic segment. All patients were discharged without any event at the postoperative second day. They were scheduled for follow-up visits and assessed by Doppler ultrasound. Currently, surgical repair is the gold standard in the treatment of AVF aneurysms. Based on our experience, we recommend surgical interventions for selected patients to maintain AVF continuation.

Utility of a tubularized extracellular matrix as an alternative conduit for arteriovenous fistula aneurysm repair

The treatment of segmental arteriovenous fistula aneurysms (AVFAs) remains a challenge in dialysis access preservation. We examined our experience with the use of tubularized extracellular matrix (ECM; CorMatrix, Roswell, Ga) for AVFA repair. Between October 2013 and January 2015, we conducted a prospective study of CorMatrix ECM for AVFA repair. All patients underwent intraoperative fistulography. Patients with central venous stenosis or occlusion had simultaneous angioplasty and stenting as indicated. The aneurysm and overlying skin were then resected, and an ECM patch was fashioned into a tube for interposition repair. Patients with multiple AVFAs underwent staged repair. Cannulation of the repaired segments was allowed after 6 weeks. During the study period, 15 patients (40% male; mean age, 49.5 years) underwent 18 AVFA repairs using ECM (3 staged repairs). Six patients (40%) underwent simultaneous treatment of central vein lesions, whereas eight patients (53%) had associated skin erosion. Treated sites included radiocephalic (2), brachiobasilic (1), and brachiocephalic (15) AVFAs. All patients had hemodialysis at an alternative location on the same extremity without the need for catheter placement. Five patients underwent a follow-up ultrasound examination at a mean of 6 weeks. All studies demonstrated patency of the ECM segments without stenosis. At a mean follow-up time of 6.9 months, two thrombosis events were observed, both in patients with known refractory central venous stenosis treated with previous angioplasty (2) and stenting (1). Both patients required new access placement. No complications were attributable to ECM sites. ECM is an alternative conduit for salvage of an autologous AVFA. This technique may help avoid the use of prosthetic grafts and hemodialysis catheters. Patients with associated central venous stenosis are at risk of thrombosis.

Suture Aneurysmorrhaphy for Salvage of Bleeding Arteriovenous Fistula Aneurysms

Aneurysmal changes are common in long-standing arteriovenous fistulas. Although typically asymptomatic, aneurysmal segments can ulcerate through the skin and produce life-threatening hemorrhage and infectious complications. We report a technique of suture aneurysmorrhaphy involving minimal manipulation of the fistula that can be used in the setting of infection and allows for both immediate and continued use of the fistula. This was a retrospective case series of suture aneurysmorrhaphy performed at a single institution between 2012 and 2015. Our technique involves resection of the anterior wall of the aneurysm with the overlying skin, followed by an aneurysmorrhaphy using the back wall of the fistula over a 16F bougie. Dialysis access is preserved proximal and distal to the repair, avoiding the need for a bridging central catheter. Sixteen patients were reviewed, with an average postoperative follow-up of 10.6 months (interquartile range, 4-16 months). Mean patient age was 57 years (range, 41-83 years), and mean duration of dialysis dependence was 6.4 years (range, 3-15 years). The aneurysmal fistula was on average 5.1 years old and most commonly transposed basilic vein (44%). Indication for intervention in the 16 patients was skin ulceration in 9 (56%), active hemorrhage in 6 (38%), and patient preference in 1 (6%). Four patients (25%) also presented with active infection involving the aneurysmal segment (infected hematoma with bacteremia in 2 of 16, and cellulitis with fever in 2 of 16). Fifteen of the 16 patients (94%) were dialyzed immediately through the fistula and thus did not require a bridging central catheter. Thirteen patients (81%) have continued to use their fistulas without need for reintervention of the treated segment. Kaplan-Meier curves are provided for primary and primary assisted patency (Figs 1 and 2). All interventions contributing to primary assisted patency were angioplasties for central stenosis, remote from the site of aneurysmorrhaphy. On follow-up, there have been no recurrent ulcerations or aneurysmal formation. We report a straightforward and effective technique to salvage aneurysmal arteriovenous fistulas. Our technique allows for salvage of bleeding fistulas without need for a bridging central catheter, can be used in the setting of infection, and appears to have acceptable midterm results.Fig 2Primary-assisted patency.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The aneurysmal arteriovenous fistula - morphological study and assessment of clinical implications. A pilot study.

Aneurysmal dilation of arteriovenous fistulae used for haemodialysis is a recognised complication but its clinical significance is a contentious issue. Our aims were to describe aneurysmal fistulae morphologically and clinically.Sixty patients underwent duplex scanning to measure the maximum diameter and skin thickness of their fistula. Haemodialysis function and bleeding risk were assessed clinically.The 75th percentile of maximum diameter was 2.05 cm. In addition to conventional diameter measurement, we describe a novel volume measurement technique which may be of value. No relationship was found between maximum diameter or volume and function, skin thickness or bleeding.Some studies define aneurysm at 2 cm (75th percentile); however, this definition and other arbitrary definitions lack clinical significance. This work suggests that fistula dilation should be considered together with clinical issues when determining the clinical significance of an aneurysm. Our finding that haemodialysis function, skin thickness and bleeding were not associated with diameter needs further study.

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Aneurysm-related complications could lead to loss of a functioning arteriovenous fistula (AVF). We report our midterm and long-term results with the staple aneurysmorrhaphy technique to repair and preserve aneurysmal AVFs. We retrospectively reviewed our surgical treatment of patients with aneurysmal autogenous AVF complicated by skin erosion, bleeding, infection, pain, and difficulty with needle access from 2007 through 2014. We identified 52 patients, 40 (77%) of whom underwent repair with the staple aneurysmorrhaphy technique. The operation involved mobilizing the entire aneurysmal segments. A TA (Covidien, Norwalk, Conn) or Endo GIA (Covidien, Mansfield, Mass) stapler was used to resect the redundant aneurysm wall to create a 6- to 8-mm-diameter conduit. A subcutaneous skin flap was created after excising compromised skin. The remodeled vein was repositioned underneath the subcutaneous flap, with the staple line rotated laterally to avoid needle puncture. We attempted staple aneurysmorrhaphy in 40 patients with complicated AVF aneurysms, of which 38 repairs (95%) were successful. Median patient age was 66 years (range, 29-88 years). Median AVF age was 63 months (range, 12-136 months). Median follow-up was 20 months (range, 5-81 months). At 1 year, primary patency was 67%, assisted primary patency was 88%, and secondary patency was 91%. At 2 years, primary patency was 59%, assisted primary patency was 84%, and secondary patency was 91%. At 3 years, primary patency was 46%, assisted primary patency was 69%, and secondary patency was 85%. Surgery was performed under local-regional anesthesia in 28 patients (70%) and under general anesthesia in the remaining 12 (30%). Proximal venous outflow stenoses were detected in 19 of 40 AVFs (48%) preoperatively and in 11 of 38 AVFs (29%) postoperatively. Aneurysm recurrence occurred in two repaired AVFs. Our experience with staple aneurysmorrhaphy shows that it is an effective, safe, and durable procedure to preserve a functioning autogenous AVF with complicated aneurysmal degeneration. Key principles are to reduce the vein to normal adjacent diameter and to provide healthy skin coverage. The remodeled AVF has a low aneurysm recurrence rate and maintains the beneficial properties of superior patency and low infection. It is important to aggressively monitor for and treat proximal outflow venous stenoses to prevent aneurysm recurrence. The surgery can be done safely under local anesthesia in selected patients.

Evaluating and treating venous outflow stenoses is necessary for the successful open surgical treatment of arteriovenous fistula aneurysms

Arteriovenous fistula (AVF) aneurysms (AVFAs) can lead to skin erosion, bleeding, difficult access while on hemodialysis, and poor cosmetic appearance. We reviewed our experience in treating patients with aneurysmal dilatation of their AVF. We reviewed clinical data of 48 patients (37 men; overall mean age, 55 years; range, 28-85 years) with an AVFA who underwent treatment during a 30-month period. Relevant clinical variables and treatment outcomes were analyzed. All patients underwent a fistulogram, and 90% required percutaneous angioplasty to improve outflow. Fifty-six percent of patients had one stenotic outflow lesion, and 44% had at least two tandem outflow stenoses that required treatment. Open repair with aneurysmorrhaphy was performed in one stage in 64% of patients and in two stages in 36%. A tunneled hemodialysis catheter was required in 11 patients (23%) until the surgically repaired AVF was ready for use again, comprising 10 patients treated with single-stage surgery and only one patient in the staged group. All AVFAs were effectively treated, and patients were able to maintain functional use of their access when healed. There is a high association of venous outflow stenoses and AVFA. Comprehensive therapy should encompass treatment of any venous outflow stenoses before open AVFA repair. A two-stage repair may decrease tunneled hemodialysis catheter use in patients with multiple aneurysms.

PS106. Aneurysm Plication Extends Life of Autologous Dialysis Fistula without Compromising Patency

The use of a native arteriovenous fistula (AVF) for dialysis is associated with fewer overall complications, and preserving long-term patency is a priority. The purpose of this study is to compare the patency and number of secondary interventions required of AVF when aneurysms are repaired with interposition prosthetic grafting (IG) vs aneurysm plication (PC). Fourteen patients with symptomatic aneurysms (15) of upper extremity autologous AVFs were treated with PC (eight) and IG (seven) between July 2007 and November 2013 at a single institution. The indications for operation were cutaneous thinning, ulceration, bleeding, and difficulty in cannulation. Patient characteristics, type of repair, patencies, and number of secondary interventions were recorded and analyzed. Fourteen consecutive patients (nine men) with mean age of 48 years, underwent 15 aneurysm repairs. Five patients (33%) had radiocephalic, nine (60%) brachiocephalic, and one (7%) brachiobasilic AVF with the mean follow-up of 9 months. Eight aneurysms (53%) underwent plication vs seven (47%) interposition grafts. The average diameter of the aneurysm was 2.6 cm (IG) and 2.8 cm (PC) (not significant). At 6 months of follow-up, the patency for PC was 62.5% vs 57.1% for the IG group (P > .4). One IG was excised due to infection and another was lost due to an unrelated death. Two patients in the PC group were converted to IG due to aneurysm extension. Overall, IG patients required eight times more procedures (five dialysis catheters and three endovascular interventions) vs 1 intervention for the PC group (P < .01). Preliminary results show that aneurysm PC extends the life of the native fistula and requires fewer interventions to maintain patency. When possible, this method should be considered as the repair procedure of choice for AVF aneurysms.

Arteriyovenöz fistül anevrizma revizyonlarında anevrizmorafi ve plikasyon: Klinik deneyimlerimiz

Background: This study aims to investigate the reliability of aneurysmorrhaphy method which allows distal dialysis access through conduit obtained from the native tissue of the patient without using an autogenous and non-autogenous grafts. Methods: Between August 2007 and February 2013, 14 patients (6 males, 8 females; mean age 54.2 years; range 28 to 74 years) with arteriovenous fistula aneurysm who underwent aneurysmorrhaphy in our clinic were retrospectively analyzed. Results: No fistula loss was seen in the early period. Only two patients (14%) needed temporary catheterization for shorter than two weeks. The mean follow-up was 13.8 months (range, 2 to 36 months). One patient died due to myocardial infarction during follow-up. Two patients (14.3%) had steal syndrome at three days and four months following the intervention. Primary fistula patency was 71.4%, while secondary fistula patency was 85.7%. Conclusion: Aneurysmorrhaphy does not require synthetic graft and saphenous vein use in the revisions of arteriovenous fistula aneurysm. It also reduces the proximal migration of the shunt and catheter need. We believe that aneurysmorrhaphy, as a safe and satisfactory technique, should be adopted widely.

Surgical repair of aneurysm of arteriovenous fistula in patients with chronic renal failure.

The aim of the studyThe aim of the study was to show the efficacy and results of aneurysm reconstruction that was developed for relieving the patients from pain and mass effects and to give an early hemodialysis option.Material and methodsMedical records were retrospectively screened over a period of 17 years to identify patients diagnosed with and surgically treated for aneurysm of an AV fistula. Twenty-eight patients were included in this study. The mean average age was 44 ± 3 years (31-60). Seventeen (60.7%) patients were female. Twenty-two (78.5%) patients had hypertension and 9 (32.1%) patients had diabetes mellitus. Aneurysm was examined by using ultrasonography to reveal the flow dynamics. The aneurysm was resected and an appropriate sized graft was interposed under local anesthesia. The same vein was dissected and anastomosed over the graft in an end-to-side fashion.ResultsMean aneurysm diameter was 40 ± 12 mm. All aneurysm tissues and thrombotic materials were removed from the surgical field. Mean graft length was 37 ± 11 mm. Three (10.7%) patients need surgical revision because of postoperative bleeding. Dermal necrosis occurred in 1 (3.5%) patient. Infection was noted in 1 (3.5%) patient. Vascular access was started from the reconstructed venous area 2 or 4 days later in all patients. The patency rate was 100% in three years.ConclusionsSurgical reconstruction of the arteriovenous fistula aneurysm can be safely performed in hemodialysis patients with low complication rates. It gives early vascular access with high patency rates. All patients are relieved from pain and distended mass effect.

Arteriovenous Fistula Aneurysm in Patients on Regular Hemodialysis: Prevalence and Risk Factors

Background/Aims: Compared to all other complications, literature data about vascular access aneurysm (VAA) are the scarcest. The aim of this cross-sectional study was to evaluate the prevalence of arteriovenous fistula (AVF) aneurysms and to confirm the risk factors for their appearance. Methods: The presence, number and morphological characteristics of AVF aneurysms were confirmed, and according to the score of AVF aneurysm (the sum of the length and width in cm), patients were classified into group 1 (score ≤12) and group 2 (score >12). Analysis included the last data from the medical records including vascular calcifications score. Results: Out of 181 patients, 150 with native fistula were included in this study. Aneurysmatic changes were detected in 90 (60%) patients, and the majority had two or more aneurysms. VAA were more frequent in patients with adult polycystic kidney disease (ADPKD) than in other diagnostic categories. By using forward stepwise logistic regression, we confirmed that patients on high-flux hemodialysis (HD) had 5.3-fold higher risk, and patients with diabetes mellitus had 5.8-fold less risk for developing AVF aneurysm. While vascular calcification score did not influence the incidence of VAA, higher PWV had significant negative influence on formation of AVF aneurysm (OR 1.25, 95% CI 1.003-1.56, p = 0.047). By ROC curve analysis, it was determined that patients who were longer than 5.7 years on HD had greater risk for developing VAA (area = 0.741, p = 0.000). Conclusion: This single-center study confirmed the very high prevalence of VAA (60%). Aneurysms were more frequent in patients with ADPKD and in those who had longer dialysis vintage on high-flux membranes with higher blood flow rate.

Hemodialysis Arteriovenous Fistula‐Related Complications and Surgery in Kidney Graft Recipients

Arteriovenous fistula (AVF) remains functional after kidney transplantation in many patients. The aim of this historical cohort study was to evaluate the data on AVF-related complications and surgery performed after kidney transplantation in our patients. The study cohort included the recipients of a kidney transplant with AVF complications between January 2006 and April 2012. 74 renal transplant recipients (47% male, mean age 51 ± 10, range 14 to 73 years) with complications related to AVF were analyzed. Among all AVFs, 51 (72%) were located in the forearm, nine (13%) in the upper arm, and 14 (15%) in the elbow. Complications occurred in 12.5% (74/592) of kidney graft recipients who were treated at our Outpatient Transplant Unit during the study period. The most common complication was painful thrombosis with or without thrombophlebitis, which occurred in 32 patients (43.2%). Other complications included growing aneurysms (27%, 20/74), venous hypertension with arm edema (8.1%, 6/74), distal hypoperfusion (8.1%, 6/74), high flow AVF with cardiac failure (8.1%, 6/74), trauma (1.3%, 1/74), and cosmetic appearance (4%, 3/74). Fifty-one surgical interventions were performed in 49 patients (mean age 52 ± 12, range 28 to 73 years). AVF closure was performed in 29/51 (56%) patients. Furthermore, an extirpation of aneurysm was performed in 12/51 (23%) and an extirpation of thrombosed AVF was performed in 1/51 (2%) patients, simple trombectomies were performed in 5/51 (10%) and a thrombectomy with reanastomosis was performed in 4/51 (8%) patients. One patient underwent percutaneous transluminal angioplasty for underlying stenosis after surgery. The most common AVF-related complications in kidney graft recipients are painful thrombosis (often accompanied with thrombophlebitis) and growing aneurysms. Surgical intervention is performed in a significant proportion of patients, mainly AVF closure, aneurysm extirpation, and thrombectomy.

Arteriovenous fistula aneurysms in patients with Alport's

Alport's syndrome is a rare but important cause of renal failure. It is characterized by Type IV collagen mutations resulting in connective tissue disorders and renal and cochlear dysfunction. Vascular basement membrane also contains collagen IV and the effect on arteriovenous fistulas (AVFs) is not reported. Anecdotally, we observed a high rate of aneurysm formation in Arteriovenous fistulas (AVF) of patients with Alport's and sought to determine whether this was the case within our population. All patients with a diagnosis of Alport's were identified from a contemporaneously maintained database. AVFs formed in patients with Alport's were identified to define the incidence of aneurysms in this group. A total of 40 patients with a diagnosis of Alport's were identified. Of these, 20 patients had undergone AVF formation, the remainder opting for CAPD as renal replacement or had undergone pre-emptive transplantation. Of the 20 patients identified, 11 had an AVF and of these the rate of aneurysm formation was high (55%). While this finding of high rate of aneurysmal AVF in Alport's patients is a purely observational finding within our population further population study would be extremely interesting and could support enhanced surveillance or alternative dialysis modalities in Alport's syndrome patients.

Popliteal Venous Pseudoaneurysm and Arteriovenous Fistula after Orthopedic Surgery

Arthroscopically assisted reconstruction of the anterior cruciate ligament (LCA) is generally a safe and effective procedure with a low rate of vascular complications. We report on a case of a 33-year-old woman with a combined arteriovenous fistula (AVF) and venous popliteal aneurysm that developed 6 months after arthroscopic anterior cruciate ligament reconstruction. At clinical exam the patient presented with left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa. CT scan showed an AVF arising from the left popliteal artery. An aneurysm was seen to fill at the same time as the popliteal vein. Findings at open surgical revision included AVF between the tibioperoneal trunk and the popliteal vein and a venous popliteal aneurysm at the level of the arteriovenous communication. The aneurysm and fistula were repaired. The patient had an uneventful follow up with complete recovery. We also report an endovascular treatment of a iatrogenic arterio-venous fistula.

Endovascular Management of Splenic Arteriovenous Fistula with Giant Venous Aneurysmal Dilatation

Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are <3 cm in diameter. Giant true splenic artery aneurysms are rare and very few lesions >10 cm have been reported. We report a case of 11 cm × 8 cm giant splenic vein aneurysm with splenic arteriovenous fistula as the 1st case of giant splenic venous aneurysm with arteriovenous fistula managed by endovascular treatment.

Successful Repair of a Ruptured Arterio-Venous Fistula Aneurysm with Femoral Vein Autograft

Successful Repair of a Ruptured Arterio-Venous Fistula Aneurysm with Femoral Vein Autograft