Enormous brachio-cephalic arteriovenous fistula aneurysm after renal transplantation: case report and review of the literature

Creation of arteriovenous fistulae provides readily available vascular access for haemodialysis in patients with end-stage renal disease. However, it is associated with various potentially serious complications if left unattended. We report a case of a 73-year-old male presenting with an enormous br...

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Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2009-11, Vol.24 (11), p.3542-3544
Main Authors: Lam, Wayne, Betal, Dibendu, Morsy, Mohammed, Chemla, Eric S.
Format: Article
Language:English
Subjects:
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
aneurysm
Aneurysm - etiology
Aneurysm - pathology
aneurysm ligation
arteriovenous fistula
Arteriovenous Shunt, Surgical - adverse effects
Biological and medical sciences
Brachial Artery - surgery
Brachiocephalic Veins - surgery
dialysis
Emergency and intensive care: renal failure. Dialysis management
Humans
Intensive care medicine
Kidney Transplantation - adverse effects
Male
Medical sciences
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
transplant
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Summary:Creation of arteriovenous fistulae provides readily available vascular access for haemodialysis in patients with end-stage renal disease. However, it is associated with various potentially serious complications if left unattended. We report a case of a 73-year-old male presenting with an enormous brachio-cephalic fistula aneurysm measuring 70–5.4 cm 20 years after successful renal transplantation. Despite attending regular renal outpatient clinic follow-up, this was only noticed as an incidental finding when the patient attended the emergency department after a fall that severely bruised his access. The patient subsequently underwent ligation with complete removal of the aneurismal fistula and discharged to a rehabilitation unit 3 days post-operatively. Systematic closure of an arteriovenous fistula should be considered in all patients after successful renal transplantation to avoid potentially catastrophic complications of an arteriovenous fistula. In patients in whom the closure of vascular access is contraindicated, it is crucial to regularly assess the status of any arteriovenous fistula when following up patients after renal transplantation.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfp337