Surgical remodeling of aneurysmal arteriovenous fistulas: Preserving vascular access and preventing complications

Arteriovenous fistulas (AVFs) are the preferred vascular access for patients with chronic kidney disease undergoing hemodialysis due to their superior long-term patency and lower infection rates compared with temporary catheters. However, over time, AVFs may develop aneurysmal dilatation, which can compromise their safety and functionality. Aneurysmal degeneration increases the risk of complications such as rupture, bleeding, infection, and difficulties with cannulation. Surgical remodeling of aneurysmal AVFs has emerged as an effective strategy to preserve a functional vascular access while preventing these complications.

We report the case of a 27-year-old female with chronic kidney disease secondary to vasculitis who had been undergoing hemodialysis for 11 years. The patient presented with a right upper extremity brachiocephalic AVF complicated by multiple aneurysmal dilatations. Phlebography demonstrated adequate fistula patency without evidence of stenosis or occlusion. Given the risk of progressive enlargement and potential complications, open surgical remodeling of the fistula was performed in order to preserve the vascular access and maintain its functionality for dialysis.

The procedure was completed successfully, preserving the fistula and avoiding the need for temporary catheter placement. The postoperative course was favorable, with maintenance of adequate vascular access for hemodialysis.

Surgical remodeling of aneurysmal AVFs represents an effective strategy for preserving long-term vascular access in hemodialysis patients. Early intervention and individualized management are essential to prevent complications and avoid the need for temporary catheters, thereby maintaining the quality and safety of dialysis treatment.

Keywords: Arteriovenous fistula; aneurysmal fistula; vascular access; hemodialysis; fistula remodeling.