Sorokin Andrey, Filippov Aleksei, Shmatov Dmitriy
Department of Cardiovascular Surgery, Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation.
J Vasc Access. 2025 Jun 18:11297298251347092. doi: 10.1177/11297298251347092.
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.
动静脉内瘘（AVF）部位的假性动脉瘤形成对接受血液透析的患者的血管通路通畅构成重大威胁。对于有多次AVF失败病史的患者，此类并发症的处理尤其具有挑战性。一名27岁的终末期肾病患者，维持性血液透析2年，在先前建立的桡动脉-贵要静脉AVF部位出现一个迅速增大的肿块（5×5×4cm）及局部皮肤改变。该患者有多次AVF血栓形成和再次重建的病史。双功超声证实为一个累及前臂流出静脉的假性动脉瘤。手术处理包括切除带有假性动脉瘤的流出静脉、游离侧支静脉、在此静脉与部分正常流出静脉之间进行端端吻合以及在贵要静脉与肱静脉之间进行端侧吻合，以确保足够的流出并将复发性血栓形成的风险降至最低。术后过程顺利，患者于术后第5天出院。术后2个月恢复通过重建的血管通路进行透析，且已保持功能超过18个月，无并发症或功能受限。该病例强调了个体化和复杂手术方法在处理AVF假性动脉瘤中的重要性。即使对于有复杂血管病史的患者，及时且量身定制的干预措施也可保留血管通路并维持生活质量。
