Surgical remodelling of haemodialysis fistula aneurysms.

INTRODUCTION: One complication of autogenous arteriovenous fistula (AVF) for haemodialysis is the formation of a venous aneurysm. CLINICAL PICTURE: The clinical picture is typically an expanding aneurysm leading to skin atrophy and ulceration with the risk of rupture and infection. Aneurysm also reduces the potential cannulation area. TREATMENT: The cases described here used a surgical 'remodelling' technique involving complete skeletonisation of the venous aneurysm, reduction of lumen diameter and retention of vein wall using a Hegar dilatator to remodel a new fistula. OUTCOME: Six patients were treated using this method and the arterior venous shunt (AVS) was used for haemodialysis the following day. No recurrent aneurysm developed.
CONCLUSION: Remodelling of aneurysmal AVF is an effective and low-risk option for managing this kind of complication, allowing direct access for haemodialysis.