Aneurysmorrhaphy vs Bypass Graft during Arteriovenous Fistula Aneurysm Management in End Stage Renal Disease Patients

Abstract

Background: Aneurysmal dilatation is considered one of the most common complications that may threaten the function of AVF and even the life of the patient if ruptured. To date, there is no gold standard approach for the management of AVF aneurysms. Objectives: To compare the outcome of aneurysmorrhaphy bypass graft regarding the patency and complication rates. Methods: This uncontrolled comparative clinical trial was conducted at Suez Canal University Hospital. Sixty-four patients were equally and randomly allocated into either Aneurysmorrhaphy or bypass graft group. Hemodialysis adult patients with aneurysmal functioning AVF were included in this study. Patients with upper limb ischemia, thrombosed AVF aneurysm, or hypotension were excluded. Results: The mean age of the studied patients was 39.8± 8.6 years. There was no significant variation either in the flow rate or in preoperative maximum diameter between the two groups. Postoperative maximum diameter was significantly higher among aneurysmorrhaphy (12.9± 3.4 mm) compared to bypass graft (6 mm) one day, one-month, and six-month postoperative with a significant decrease in the diameter of both groups compared to the preoperative diameter. Post-operative edema, hematoma, and thrombosis were higher in group A, while after six months infection and thrombosis were higher in group B. Conclusion: Aneurysmorrhaphy showed higher patency outcomes, post-operative maximum diameter, and thrombosis. While the bypass graft showed a higher incidence of infection