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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.