Upper extremity reconstruction following open surgical repair of giant arteriovenous fistula aneurysm: Clinical case and systematic review of the literature

Tariq A. Almerey, Jeremie D. Oliver, Matthew S. Jorgensen, Brian D. Rinker, Houssam A. Farres, Albert G. Hakaim, Antonio J. Forte

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Nearly 30% of arteriovenous fistulas (AVFs) located in the upper extremity for hemodialysis access result in short-and long-term adverse effects, such as rupture, necessitating emergent surgical management and extensive soft-tissue reconstruction. With this systematic review, we aimed to compile all reported open surgical techniques used for complicated AVF repair in the upper extremity, the respective soft-tissue reconstructive outcomes, and vascular patency rates at final follow-up. Methods: Using Ovid Medline/PubMed databases, we conducted a review of the English-language literature on AVF aneurysm surgical management in the upper extremity, filtered for relevance to open surgical technique and outcomes in vascular patency after aneurysmal repair at long-term follow-up (≥6 months postoperatively). We include a detailed case of surgical removal of a giant AVF aneurysm and subsequent flap elevation and reconstruction of the upper extremity. Results: Of 150 articles found in the initial search, 19 (from 2010-2017) met inclusion criteria. From the reviewed studies, 675 patients underwent open surgical repair of AVF aneurysm in the upper extremity. Surgical approaches included partial-to-full aneurysm excision, interposition graft, tubularized extracellular matrix, sutured and stapled aneurysmorrhaphy, and stent graft. Rates of vascular patency at repair site ranged from 47% to 100%, with a pooled average of 78% at 6 months or longer postoperatively. Conclusions: For plastic and hand surgeons, aneurysmal ligation and excision is feasible even in severe cases and is associated with overall good vascular and soft-tissue reconstructive outcomes in the upper extremity. (www.actabiomedica.it).

Original languageEnglish (US)
Article numbere2020093
Pages (from-to)1-8
Number of pages8
JournalActa Biomedica
Volume91
Issue number4
DOIs
StatePublished - 2020

Keywords

  • Aesthetic outcome
  • AV fistula
  • AVF
  • Dialysis
  • Reconstruction; upper extremit

ASJC Scopus subject areas

  • Medicine(all)

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