BACKGROUND: To present a case of banding failure with vessel wall erosion and pseudo-aneurysm creation caused by the suture. CASE REPORT: A 75-year-old male patient was operated for a high-flow fistula (>2 L/min). This was overall the third time that the patient was operated for the same indication since he started dialysis 5 years ago. Standard banding technique with perioperative flow measurements was used, and three separate Prolene sutures tied over 5 and 4.5 mm probes to achieve flow reduction. The operation was successful and first few weeks were uneventful. However, 5-6 weeks postoperatively, the patient felt locally an acute pain that lasted only few seconds and a voluminous aneurysm occurred progressively within the next few weeks. He was observed 2 months after the first operation where a recurrent high-flow fistula was diagnosed and ultrasound examination revealed that the sutures used for banding were into the vessel lumen while a pseudo-aneurysm had occurred at the same level. The patient was re-operated for excision of the aneurysm and flow reduction with tapering of the anastomosis. CONCLUSION: Under certain conditions, the suture used for banding may erode through the vessel wall and get into the lumen. This will result in recurrence of a high-flow fistula. While this has been previously described, the phenomenon was otherwise uneventful. In contrary, in the case presented herein, a potentially threatening pseudo-aneurysm has occurred.
BACKGROUND: To present a case of banding failure with vessel wall erosion and pseudo-aneurysm creation caused by the suture. CASE REPORT: A 75-year-old male patient was operated for a high-flow fistula (>2 L/min). This was overall the third time that the patient was operated for the same indication since he started dialysis 5 years ago. Standard banding technique with perioperative flow measurements was used, and three separate Prolene sutures tied over 5 and 4.5 mm probes to achieve flow reduction. The operation was successful and first few weeks were uneventful. However, 5-6 weeks postoperatively, the patient felt locally an acute pain that lasted only few seconds and a voluminous aneurysm occurred progressively within the next few weeks. He was observed 2 months after the first operation where a recurrent high-flow fistula was diagnosed and ultrasound examination revealed that the sutures used for banding were into the vessel lumen while a pseudo-aneurysm had occurred at the same level. The patient was re-operated for excision of the aneurysm and flow reduction with tapering of the anastomosis. CONCLUSION: Under certain conditions, the suture used for banding may erode through the vessel wall and get into the lumen. This will result in recurrence of a high-flow fistula. While this has been previously described, the phenomenon was otherwise uneventful. In contrary, in the case presented herein, a potentially threatening pseudo-aneurysm has occurred.
Authors: Alexandros Mallios; Antoine Gaudin; Alexandra Hauguel; Romain de Blic; Benoit Boura; William C Jennings Journal: J Vasc Surg Cases Innov Tech Date: 2022-01-27