Letter to the Editor
Juxtaanastomotic venous aneurysms in arteriovenous fistulas for hemodialysis
Aneurismas venosos yuxtaanastomóticos en fístulas arteriovenosas para hemodiálisis
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Exclusion of the aneurysm with PTFE-coated humerocephalic stent.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Venous aneurysms in the arteriovenous fistulas (AVF) are common, between 5% and 60% according to the series and the definition of aneurysm being used.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> In the majority of cases there is secondary weakness in the vessel wall due to repeated punctures. They are true dilations of the vessel, which conserves all its layers, unlike pseudoaneurysms, in which a rupture of the vascular wall.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are circumstances that favor the development of aneurysms, such as vessel weakness associated with conditions such as Alport syndrome<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> or polycystic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The presence of proximal stenosis also fosters the onset and growth of aneurysms.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of venous aneurysm is based on clinical findings, but conducting a Doppler ultrasound helps the diagnosis; it allows the measurement of the calibre and detects the presence of associated stenosis and intraluminal thrombus.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Juxta-anastomotic venous aneurysms (JVA) are rare (less than 2% of the total) and are distinguished from the rest by their pathogenesis and evolution.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We present 4 cases of JVA treated with different surgical techniques since anatomical and clinical situations were different in each case.</p><p id="par0030" class="elsevierStylePara elsevierViewall">They all grew and presented signs of cutaneous ischaemia.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>: Radiocephalic AVF. Transplanted patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment: JVA resection after fistula ligation, since access was not needed.</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2</span>: Radiocephalic AVF. JVA and poor blood flow in dialysis sessions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment: new proximal anastomosis after aneurysm resection.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 3</span>: Humerocephalic AVF.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment: JVA resection and reconstruction with median accessory cephalic vein (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 4</span>: Humerocephalic AVF.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment: initially, angioplasty of a stenosis proximal to the aneurysm. The result was not satisfactory and it was decided a new intervention.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Autogenic reconstruction was not possible, the juxta-anastomotic aneurysm and another proximal one secondary to punctures was excluded by means of interposition of a PTFE-covered stent between the humeral artery and the proximal cephalic vein was ruled out (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">No patient presented post-operative complications.</p><p id="par0085" class="elsevierStylePara elsevierViewall">It was possible to use all AVFs in the following dialysis session and they remain permeable, except the AVF that was ligated because he was a transplanted patient.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Treatment of venous aneurysms in AVFs is justified because it carries the risk of rupture and massive haemorrhage, which may cause death, excess of blood flow, pain due to compression of surrounding structures, epidermal necrosis, infection, stenosis due to partial thrombosis, inability to puncture the AVF, venous hypertension, or negative cosmetic effects.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The various therapeutic options can be grouped into conservative, intravascular, or surgical treatment: exclusion with or without resection, aneurysmorrhaphy, with a possible need for a new autogenous or prosthetic AVF. In the event that the AVF is not going to be used, ligation is indicated.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Endoprosthesis offers the advantage of correcting the stenosis associated with VA in the same procedure. But the subsequent punctures are more difficult and, occasionally, it still require aneurysmorrhaphy or simultaneous excision.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The JVAs are rare and can be identified because they are not due to weakening of the vessel wall secondary to punctures.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The literature on this type of aneurysm and its treatment is scarce. Our experience differs from that published by Valenti et al., who advise an expectant attitude since growth of the aneurysm occurred and signs of cutaneous ischaemia appeared in all cases, which required intervention. This evolution seems logical, since the existence of proximal stenosis was demonstrated in all cases.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Angioplasty of the proximal stenosis was only conducted in case 4, to allow an expectant attitude, but a relapse of the stenosis occurred and the aneurysm grew up again. In case 3, an angio CT scan was necessary to analyze the anatomy of the aneurysm. Given the characteristics thereof, intervention by radiology was not advisable.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the radiocephalic AVFs, it was decided to proceed with surgical treatment, in one case because the AVF was unnecessary and in the other case we followed our protocol that includes the performance of a new proximal anastomosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">JVAs are rare and the pathogenesis is different to that of aneurysms secondary to puncture.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our experience, they are associated with proximal stenosis, and they grow up and require treatment due to the risk of cutaneous ischaemia and rupture.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conclusions" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Almonacid P, Pila U, Gruss E, Lasala M, Rueda JA, Colás E, et al. Aneurismas venosos yuxtaanastomóticos en fístulas arteriovenosas para hemodiálisis. Nefrologia. 2018;38:454–457.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1930 "Ancho" => 1600 "Tamanyo" => 411555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 3: Humerocephalic AVF. Resection and reconstruction with median accessory cephalic vein</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2012 "Ancho" => 1000 "Tamanyo" => 332181 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 4: Humerocephalic AVF. Exclusion of the aneurysm with PTFE-coated humerocephalic stent.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://www.senefro.org/modules/webstructure/files/guia_FAV.zip">http://www.senefro.org/modules/webstructure/files/guia_FAV.zip</a> [accessed 23.2.17]." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 84 | 32 | 116 |
| 2024 September | 136 | 32 | 168 |
| 2024 August | 156 | 58 | 214 |
| 2024 July | 146 | 36 | 182 |
| 2024 June | 114 | 37 | 151 |
| 2024 May | 111 | 35 | 146 |
| 2024 April | 105 | 41 | 146 |
| 2024 March | 104 | 36 | 140 |
| 2024 February | 134 | 51 | 185 |
| 2024 January | 162 | 27 | 189 |
| 2023 December | 288 | 38 | 326 |
| 2023 November | 283 | 67 | 350 |
| 2023 October | 267 | 40 | 307 |
| 2023 September | 226 | 31 | 257 |
| 2023 August | 239 | 25 | 264 |
| 2023 July | 213 | 26 | 239 |
| 2023 June | 221 | 17 | 238 |
| 2023 May | 175 | 31 | 206 |
| 2023 April | 213 | 16 | 229 |
| 2023 March | 137 | 28 | 165 |
| 2023 February | 98 | 21 | 119 |
| 2023 January | 111 | 25 | 136 |
| 2022 December | 140 | 37 | 177 |
| 2022 November | 109 | 37 | 146 |
| 2022 October | 137 | 51 | 188 |
| 2022 September | 127 | 40 | 167 |
| 2022 August | 116 | 57 | 173 |
| 2022 July | 101 | 43 | 144 |
| 2022 June | 112 | 40 | 152 |
| 2022 May | 152 | 28 | 180 |
| 2022 April | 149 | 52 | 201 |
| 2022 March | 132 | 60 | 192 |
| 2022 February | 119 | 45 | 164 |
| 2022 January | 130 | 50 | 180 |
| 2021 December | 120 | 46 | 166 |
| 2021 November | 107 | 42 | 149 |
| 2021 October | 102 | 52 | 154 |
| 2021 September | 90 | 41 | 131 |
| 2021 August | 85 | 41 | 126 |
| 2021 July | 78 | 40 | 118 |
| 2021 June | 75 | 48 | 123 |
| 2021 May | 115 | 55 | 170 |
| 2021 April | 154 | 63 | 217 |
| 2021 March | 131 | 32 | 163 |
| 2021 February | 131 | 28 | 159 |
| 2021 January | 80 | 24 | 104 |
| 2020 December | 69 | 12 | 81 |
| 2020 November | 84 | 17 | 101 |
| 2020 October | 54 | 20 | 74 |
| 2020 September | 63 | 13 | 76 |
| 2020 August | 71 | 16 | 87 |
| 2020 July | 73 | 14 | 87 |
| 2020 June | 74 | 27 | 101 |
| 2020 May | 68 | 16 | 84 |
| 2020 April | 64 | 16 | 80 |
| 2020 March | 67 | 15 | 82 |
| 2020 February | 83 | 25 | 108 |
| 2020 January | 112 | 27 | 139 |
| 2019 December | 86 | 39 | 125 |
| 2019 November | 87 | 19 | 106 |
| 2019 October | 108 | 16 | 124 |
| 2019 September | 118 | 24 | 142 |
| 2019 August | 87 | 23 | 110 |
| 2019 July | 80 | 29 | 109 |
| 2019 June | 66 | 41 | 107 |
| 2019 May | 73 | 30 | 103 |
| 2019 April | 122 | 48 | 170 |
| 2019 March | 51 | 18 | 69 |
| 2019 February | 34 | 23 | 57 |
| 2019 January | 57 | 25 | 82 |
| 2018 December | 148 | 44 | 192 |
| 2018 November | 106 | 17 | 123 |
| 2018 October | 158 | 18 | 176 |
| 2018 September | 77 | 15 | 92 |
| 2018 August | 92 | 20 | 112 |
| 2018 July | 55 | 14 | 69 |
| 2018 June | 67 | 8 | 75 |
| 2018 May | 59 | 12 | 71 |
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