𝗖𝗔𝗦𝗘 01
ɢɪᴀɴᴛ ᴀɴᴇᴜʀʏꜱᴍᴀʟ ʙʀᴀᴄʜɪᴏᴄᴇᴘʜᴀʟɪᴄ ᴀᴠꜰ ɪɴ ᴀ ʏᴏᴜɴɢ ʜᴇᴍᴏᴅɪᴀʟʏꜱɪꜱ ᴘᴀᴛɪᴇɴᴛ – ꜱᴜᴄᴄᴇꜱꜱꜰᴜʟ ᴀᴄᴄᴇꜱꜱ-ᴘʀᴇꜱᴇʀᴠɪɴɢ ꜱᴜʀɢᴇʀʏ
One of the most challenging complications of long-term hemodialysis access is the development of a giant aneurysmal arteriovenous fistula.
This young lady with chronic kidney disease had developed progressive aneurysmal degeneration of a left brachiocephalic AV fistula over several years. The fistula had enlarged dramatically, producing a giant high-flow aneurysmal access with significant cosmetic deformity and increasing risks of skin breakdown, spontaneous bleeding, thrombosis, venous hypertension, and eventual cardiac complications.
An important feature of this case was the presence of a functioning ipsilateral radiocephalic AV fistula, which was being successfully used for maintenance hemodialysis.
After detailed evaluation and surgical planning, we proceeded with ligation of the giant brachiocephalic AVF at its origin and excision of the aneurysmal venous segment. The operation was completed safely without immediate complications.
Most importantly, the distal radiocephalic AV fistula remained completely unaffected following ligation. Postoperatively it demonstrated a preserved thrill, satisfactory flow characteristics, and continued functionality for hemodialysis.
Cases such as this highlight several important principles in vascular access surgery:
Long-standing high-flow AVFs require regular surveillance.
Giant aneurysmal degeneration should be addressed before rupture or skin complications occur.
Every effort should be made to preserve existing dialysis access whenever feasible.
Careful surgical planning can allow definitive treatment of a diseased fistula while maintaining uninterrupted renal replacement therapy.
The accompanying photographs demonstrate the remarkable aneurysmal degeneration before surgery and the early postoperative result following successful ligation and excision.
Vascular surgery is often not simply about removing pathology it is about preserving the patient's future lifeline.
Patient identity and confidentiality fully protected. Images shared with appropriate consent for educational purposes
𝗞𝗲𝘆 𝗠𝗲𝘀𝘀𝗮𝗴𝗲: Preserve the patient’s dialysis lifeline whenever possible.
