Complex reconstructive procedure for pseudoaneurysm in arteriovenous fistula: A clinical case

Pseudoaneurysm formation at the site of arteriovenous fistula (AVF) poses a significant threat to vascular access patency in patients undergoing hemodialysis. Management of such complications is particularly challenging in patients with a history of multiple AVF failures. A 27-year-old patient with end-stage renal disease on maintenance hemodialysis for 2 years presented with a rapidly enlarging mass (5 × 5 × 4 cm) and local skin changes at the site of a previously created radial artery-basilic vein AVF. The patient had a history of multiple AVF thromboses and redo reconstructions. Duplex ultrasound confirmed a pseudoaneurysm involving the outflow vein on the forearm. Surgical management included excision of the outflow vein with the pseudoaneurysm, mobilization of collateral vein, creation of an end-to-end anastomosis between this vein and part of normal outflow vein and creation of an end-to-side anastomosis between the basilic vein and the brachial vein to ensure adequate outflow and minimize the risk of recurrent thrombosis. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Dialysis via the reconstructed vascular access was resumed 2 months after surgery and has remained functional for over 18 months without complications or limitations. This case highlights the importance of individualized and complex surgical approaches for the management of AVF pseudoaneurysms. Timely and tailored interventions can preserve vascular access and maintain quality of life, even in patients with complex vascular histories.