Giant pseudoaneurysm of an autologous arteriovenous fistula in the forearm: surgical repair
Pseudoaneurisma gigante de fístula arteriovenosa humeral autóloga: reparación quirúrgica
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González López, Sergio González González, S. González González, Ricardo J. Muñoz García, R.J. Muñoz García, B. Ramos Frendo, Blanca Ramos Frendo, Pedro J. Aranda Granados, P.J. Aranda Granados, Julio Gutiérrez de Loma, J. Gutiérrez de Loma" "autores" => array:12 [ 0 => array:4 [ "nombre" => "Mª Teresa" "apellidos" => "González López" "email" => array:1 [ 0 => "draglezlopez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "Iniciales" => "M.T." 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"apellidos" => "Muñoz García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 6 => array:3 [ "Iniciales" => "B." "apellidos" => "Ramos Frendo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 7 => array:3 [ "nombre" => "Blanca" "apellidos" => "Ramos Frendo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 8 => array:3 [ "nombre" => "Pedro J." "apellidos" => "Aranda Granados" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 9 => array:3 [ "Iniciales" => "P.J." "apellidos" => "Aranda Granados" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 10 => array:3 [ "nombre" => "Julio" "apellidos" => "Gutiérrez de Loma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 11 => array:3 [ "Iniciales" => "J." "apellidos" => "Gutiérrez de Loma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Cardiovascular, Hospital Regional Universitario Carlos Haya, Málaga, Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Cardiovascular, Hospital Regional Universitario Carlos Haya, Málaga, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Regional Universitario Carlos Haya, Málaga, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudoaneurisma gigante de fístula arteriovenosa humeral autóloga: reparación quirúrgica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10836_108_19862_en_10836_f1.jpg" "Alto" => 720 "Ancho" => 486 "Tamanyo" => 54680 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Advances in treating end-stage chronic kidney disease have made vascular access one of the most common interventions for vascular surgeons. As with any other surgical procedure, it is not exempt from complications, and patients may present with thrombosis, haemorrhage, infection, steal syndrome, venous hypertension or long-term formation of pseudoaneurysms. The development of this last condition does not only mean that the fistula has a shorter useful life, it also involves greater risk of graft thrombosis, infection, difficulty in access or even rupture.</p><p class="elsevierStylePara">We present the case of a giant pseudoaneurysm of an upper-arm autologous arteriovenous fistula, which required surgical treatment to be resolved.</p><p class="elsevierStylePara">A 61-year-old man, diagnosed with chronic renal failure of unknown origin since 1975, when started on regular haemodialysis. Since then, he has received a total of three kidney transplants, having been a recipient for 20 years. Two years ago, he was included once more on a haemodialysis programme (using a central venous catheter). Other interesting aspects of his medical history were: arterial hypertension, insulin-dependent diabetes mellitus, C virus chronic liver disease and surgical repair of pseudoaneurysm developed on an arteriovenous fistula in the contralateral arm (left).</p><p class="elsevierStylePara">In the last three years, the patient developed a pulsatile tumour in a previous fistula in the right upper arm, compatible with a pseudoaneurysm. After it sharply increased in size during recent months (Figure 1a), a computerised angiotomography (angio-CT) was requested which showed that axillary and subclavian arteries were permeable, the humeral artery was very calcified and fistula in the flexure of the right forearm with a giant pseudoaneurysm of 63x57mm.</p><p class="elsevierStylePara">Following these observations, surgery was indicated to close the fistula. We used a cuff on the high upper arm to produce ischaemia and control the bleeding during the opening. We performed a longitudinal incision on the pseudoaneurysm (Figure 1) so that the original path of the humeral artery could be located (Figure 2a) and the humero-humeral bypass was performed with a 6-mm Dacron prosthetic graft. The blood flow towards the limb (Figure 2b) was fully re-established.</p><p class="elsevierStylePara">Vascular access complications are responsible for 15% of haemodialysis patients’ hospital admissions.<span class="elsevierStyleSup">1</span> For that reason, a multidisciplinary approach must be used to detect them early.<span class="elsevierStyleSup">2</span> Pseudoaneurysms are relatively uncommon complications, and their incidence is even less in autologous fistulae, compared to those performed with a polytetrafluoroethylene (PTFE) graft.<span class="elsevierStyleSup">3</span> In those cases that reach a small size, endovascular treatment (covered stent or thrombin injection) may be enough to try and prolong the vascular access’s life.<span class="elsevierStyleSup">4</span> In contrast, for cases such as that described, open surgery is the only effective treatment for avoiding events that require urgent action.</p><p class="elsevierStylePara"><a href="grande/10836_108_19862_en_10836_f1.jpg" class="elsevierStyleCrossRefs"><img src="10836_108_19862_en_10836_f1.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p><p class="elsevierStylePara"><a href="grande/10836_108_19863_en_10836_f2.jpg" class="elsevierStyleCrossRefs"><img src="10836_108_19863_en_10836_f2.jpg"></img></a></p><p class="elsevierStylePara">Figure 2. </p>" "pdfFichero" => "P1-E523-S3023-A10836-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10836_108_19862_en_10836_f1.jpg" "Alto" => 720 "Ancho" => 486 "Tamanyo" => 54680 ] ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10836_108_19863_en_10836_f2.jpg" "Alto" => 720 "Ancho" => 478 "Tamanyo" => 77508 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chazan JA, London MR, Pono LM. Long-term survival of vascular accesses in a large chronic hemodialysis population. Nephron 1995;69:228-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7753253" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Flu H, Breslau PJ, Krol-Van Straaten JM, Hamming JF, Lardenoye JW. The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery. J Vasc Surg 2008;48(3):659-68. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18572358" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zibari GB, Rohr MS, Landreneau MD. Complications from permanent hemodyalisis vascular access. Surgery 1988;104:681-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3175866" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pou M, Saurina A, Falcó J, De las Cuevas X. Angioradiology as diagnosis and treatment of a pseudoaneurysm in an internal arteriovenous fistula. Nefrologia 2004;24(4):380-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15455501" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000004/v0_201502091636/X201325141105210X/v0_201502091637/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000004/v0_201502091636/X201325141105210X/v0_201502091637/en/P1-E523-S3023-A10836-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141105210X?idApp=UINPBA000064" ]
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| 2022 July | 48 | 48 | 96 |
| 2022 June | 67 | 31 | 98 |
| 2022 May | 63 | 48 | 111 |
| 2022 April | 72 | 58 | 130 |
| 2022 March | 76 | 52 | 128 |
| 2022 February | 67 | 39 | 106 |
| 2022 January | 74 | 31 | 105 |
| 2021 December | 75 | 43 | 118 |
| 2021 November | 55 | 34 | 89 |
| 2021 October | 77 | 45 | 122 |
| 2021 September | 44 | 44 | 88 |
| 2021 August | 52 | 36 | 88 |
| 2021 July | 66 | 30 | 96 |
| 2021 June | 53 | 31 | 84 |
| 2021 May | 51 | 34 | 85 |
| 2021 April | 192 | 55 | 247 |
| 2021 March | 86 | 32 | 118 |
| 2021 February | 47 | 12 | 59 |
| 2021 January | 47 | 15 | 62 |
| 2020 December | 49 | 15 | 64 |
| 2020 November | 42 | 20 | 62 |
| 2020 October | 33 | 23 | 56 |
| 2020 September | 30 | 4 | 34 |
| 2020 August | 49 | 14 | 63 |
| 2020 July | 57 | 8 | 65 |
| 2020 June | 40 | 19 | 59 |
| 2020 May | 55 | 11 | 66 |
| 2020 April | 47 | 16 | 63 |
| 2020 March | 26 | 13 | 39 |
| 2020 February | 33 | 16 | 49 |
| 2020 January | 47 | 21 | 68 |
| 2019 December | 50 | 28 | 78 |
| 2019 November | 63 | 26 | 89 |
| 2019 October | 47 | 10 | 57 |
| 2019 September | 38 | 15 | 53 |
| 2019 August | 18 | 8 | 26 |
| 2019 July | 44 | 23 | 67 |
| 2019 June | 35 | 5 | 40 |
| 2019 May | 34 | 10 | 44 |
| 2019 April | 70 | 39 | 109 |
| 2019 March | 39 | 19 | 58 |
| 2019 February | 31 | 16 | 47 |
| 2019 January | 50 | 25 | 75 |
| 2018 December | 109 | 37 | 146 |
| 2018 November | 108 | 17 | 125 |
| 2018 October | 126 | 17 | 143 |
| 2018 September | 100 | 17 | 117 |
| 2018 August | 50 | 16 | 66 |
| 2018 July | 70 | 14 | 84 |
| 2018 June | 57 | 10 | 67 |
| 2018 May | 55 | 14 | 69 |
| 2018 April | 58 | 10 | 68 |
| 2018 March | 47 | 4 | 51 |
| 2018 February | 60 | 5 | 65 |
| 2018 January | 57 | 4 | 61 |
| 2017 December | 56 | 10 | 66 |
| 2017 November | 42 | 6 | 48 |
| 2017 October | 35 | 10 | 45 |
| 2017 September | 49 | 9 | 58 |
| 2017 August | 36 | 7 | 43 |
| 2017 July | 42 | 9 | 51 |
| 2017 June | 31 | 36 | 67 |
| 2017 May | 56 | 9 | 65 |
| 2017 April | 46 | 18 | 64 |
| 2017 March | 33 | 8 | 41 |
| 2017 February | 110 | 9 | 119 |
| 2017 January | 34 | 9 | 43 |
| 2016 December | 38 | 10 | 48 |
| 2016 November | 54 | 6 | 60 |
| 2016 October | 119 | 13 | 132 |
| 2016 September | 195 | 8 | 203 |
| 2016 August | 152 | 8 | 160 |
| 2016 July | 158 | 14 | 172 |
| 2016 June | 129 | 0 | 129 |
| 2016 May | 111 | 0 | 111 |
| 2016 April | 100 | 0 | 100 |
| 2016 March | 66 | 0 | 66 |
| 2016 February | 85 | 0 | 85 |
| 2016 January | 104 | 0 | 104 |
| 2015 December | 103 | 0 | 103 |
| 2015 November | 54 | 0 | 54 |
| 2015 October | 83 | 0 | 83 |
| 2015 September | 73 | 0 | 73 |
| 2015 August | 71 | 0 | 71 |
| 2015 July | 104 | 0 | 104 |
| 2015 June | 33 | 0 | 33 |
| 2015 May | 52 | 0 | 52 |
| 2015 April | 9 | 0 | 9 |
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