Author(s):

Hakeem Zubair Ashraf*, Mohd Yaqoob Khan, Abid Aziz Kangoo, Nadeem-Ul-Nazeer Kawoosa, Farooq Ahmad Ganie, Haroon Naqshi, Abdul Majeed Dar and Ghulam Nabi Lone

Aim: To study the outcome and therapeutic validity of surgical management of juxta-anastomotic aneurysms in native arterio-venous fistulae in chronic kidney disease patients on hemodialysis.

Material and Methods: We included fifty patients of Chronic kidney disease who were on maintenance haemodialysis in the Department of Nephrology and had developed arteriovenous aneurysmal swellings during the course of repeated vessel puncture and cannulations. The morpho-volumetric quantification of the aneurysms and blood flow pattern studies were made. After proper medical optimization, patients were taken up for surgical exploration of the aneurysmal fistulae.

Results: The group included 22 males and 28 females with a mean age of 47 (+/-7) years. The mean period of aneurysm formation was 22 (+/-8) months.The mean size of the aneurysmal sac was 42 (+/-7) mm in the largest dimension. The true venous aneurysms included 34 while as 3 were arterial. Remaining 13 were mixed type. The mean operating time was 88 (+/-17) minutes. The mean post operative stay was two days. There was no hospital mortality.

Conclusion: Un-natural anatomical vascular alterations inflicted during arteriovenous fistula creation have unpredictable healing and adaptation behaviour. Aneurysms are among the late unwanted complications. This poses great threat to patients limb and life both. Timely evaluation and liberal surgical address alleviates these risks and additionally provides a long lasting vascular access pathway with low complication and high patency rates.