Surgical modalities for salvage of aneurysm of arteriovenous access

Background: Aneurysmal dilation of arteriovenous (AV) fistulas is not an uncommon occurrence. True aneurysms andpseudoaneurysms are two types of AV fistula aneurysms.Aim: The aim of the study was to evaluate the different surgical modalities for the management of AV aneurysmaldilatation as a complication of AV access for dialysis in patients with end-stage renal disease on regular hemodialysis(ESRD) regarding the feasibility, patency, clinical success, access salvage rates, and complications.Patients and Methods: This study is prospective and was conducted on 18 patients with AV aneurysmal dilatation withESRD as a complication of AV access for dialysis at Beni-Suef University Hospital, Department of Vascular and GeneralSurgery from December 2020 to May 2022.Results: The current study showed that the only significant variable that affected the occurrence of complications was thetype of operation, as no complications were detected in aneurysmectomy, and end-to-end anastomosis was least detected in aneurysmectomy and graft. There was a significantly higher operative time in patients with general anesthesia than in local and regional. Also, the operative time of patients with regional anesthesia was significantly higher than that with local anesthesia.Conclusion: The different surgical modalities for the management of AV aneurysmal dilatation as a complication of AVaccess for dialysis in patients with ESRD can be used safely with good clinical success to salvage VARA (Vascular accessRelated aneurysm) with minimal complications; the least was detected to be related to aneurysmorrhaphy, followed byaneurysmectomy with an interposition graft. When we confirm central vein stenosis, we advise endovascular treatmentfor the underlying stenosis. Finally, conservative treatment is preferred for asymptomatic aneurysmal fistulae.