Concomitant Staple Aneurysmorrhaphy and Flow-Calibrated Arteriovenous Fistula Banding Over a Coronary Dilator to Treat Hand Steal Syndrome

Abstract

Background:

True venous aneurysm formation can occur in patients with arteriovenous fistulas (AVFs) for hemodialysis but association with steal syndrome is uncommon.

Methods:

To describe a case of a patient on chronic hemodialysis through a right brachiocephalic fistula, who presents with associated steal syndrome and true arteriovenous access aneurysm.

Results:

A 34-year-old female with true AVF aneurysm presented with hand steal syndrome confirmed by noninvasive studies. The patient underwent a successful vein aneurysmorrhaphy with a commercially available stapler device and duplex ultrasound flow-calibrated banding. At 1-year follow-up, she remains pain free and the fistula remains functional with no recurrence of venous aneurysmal degeneration.

Conclusion:

The use of a commercially available surgical stapler devices along with flow-calibrated banding guided by duplex ultrasound over a coronary dilator during the same operation is an elegant, efficacious, and a durable alternative for patients with hand steal syndrome and concomitant AVF aneurysms.

Keywords

dialysis hand steal syndrome banding staple aneurysmorrhaphy

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References

Gilmore

. KDOQI clinical practice guidelines and clinical practice recommendations—2006 updates. Nephrol Nurs J. 2006;33(5):487–488.

Jankovic

Donfrid

Adam

. Arteriovenous fistula aneurysm in patients on regular hemodialysis: prevalence and risk factors. Nephron Clin Pract. 2013;124(1-2):94–98.

Georgiadis

Lazarides

Panagoutsos

. Surgical revision of complicated false and true vascular access-related aneurysms. J Vasc Surg. 2008;47(6):1284–1291.

Pasklinsky

Meisner

Labropoulos

. Management of true aneurysms of hemodialysis access fistulas. J Vasc Surg. 2011;53(5):1291–1297.

Hossny

. Partial aneurysmectomy for salvage of autogenous arteriovenous fistula with complicated venous aneurysms. J Vasc Surg. 2014;59(4):1073–1077.

Georgiadis

Lazarides

Lambidis

. Use of short PTFE segments (<6 cm) compares favorably with pure autologous repair in failing or thrombosed native arteriovenous fistulas. J Vasc Surg. 2005;41(1):76–81.

Pierce

Thomas

Fenton

. Novel repair of venous aneurysms secondary to arteriovenous dialysis fistulae. Vasc Endovascular Surg. 2007;41(1):55–60.

Tumbaga

Aka

Behseresht

Hsu

Tayarrah

. Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications. J Vasc Surg. 2015;61(2):457–462.

Piccolo

3rd Madden

Famularo

Domer

Mannella

. Partial aneurysmectomy of venous aneurysms in arteriovenous dialysis fistulas. Vasc Endovascular Surg. 2015;49(5-6):124–128.

10.

Tozzi

Franchin

Ietto

. A modified stapling technique for the repair of an aneurysmal autogenous arteriovenous fistula. J Vasc Surg. 2014;60(4):1019–1023.

11.

Bagdasarian

Heung

Malani

. Infectious complications of dialysis access devices. Infect Dis Clin North Am. 2012;26(1):127–141.

12.

Gkotsis

Jennings

Malik

Mallios

Taubman

. Treatment of high flow arteriovenous fistulas after successful renal transplant using a simple precision banding technique. Ann Vasc Surg. 2016;31:85–90.

13.

Almehmi

Wang

. Partial aneurysmectomy is effective in managing aneurysm-associated complications of arteriovenous fistulae for hemodialysis: case series and literature review. Semin Dial. 2012;25(3):357–364.

14.

Woo

Cook

Garg

Hye

Canty

. Midterm results of a novel technique to salvage autogenous dialysis access in aneurysmal arteriovenous fistulas. J Vasc Surg. 2010;51(4):921–925, 925 e1.