Reconstructive operations for aneurysmatic transformation of veins in patients on programmed haemodialysis

Baykov B.V., Zulkarnaev A.B., Yankovoy A.G., Strugailo E.V.

Surgical Department of Transplantology and Dialysis, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia

Aneurysmatic transformation of a fistulous vein is one of the most frequently encountered complications in patients on programmed dialysis. This complication increases the risk of dysfunction of an arteriovenous fistula. However, there are no common approaches to correction of this complication.

This study was aimed at assessing the results of aneurysmorrhaphy for treating aneurysms of fistulous veins in patients on programmed dialysis. For this purpose, we carried out a retrospective analysis of the results of operations in a total of 87 patients with aneurysmatic transformation of an arteriovenous fistula. All patients were subjected to aneurysmorrhaphy supplemented, if necessary, by plasty of stenosis with the use of the tissue of the wall of the resected aneurysm. The vein was placed into a new subcutaneous channel (transposition with transection of the vein) or a pocket formed by the separated subcutaneous tissue (transposition without transection). Secondary patency after 1 year amounted to 95.3%, after 2 years to 91.4%, and after 3 years to 87.6%. At 4.8 years, 69% (95% CI 44.9-84.2) of the arteriovenous fistulas proved patent.

Conclusion. Aneurysmorrhaphy supplemented with correction of concomitant complications of aneurysms of fistulous veins is an effective and safe operation making it possible to maintain the function of an arteriovenous fistula for a long period of time.

KEY WORDS: arteriovenous fistula, aneurysm, aneurysmorrhaphy, stenosis, vascular approach, haemodialysis.

P. 104

« Back