A Retrospective Study on Surgical Management of Postarteriovenous Access Pseudoaneurysm

Objectives: The objective of this study was to find out the factors determining the feasibility of fistula salvage in patients diagnosed with pseudoaneurysm (PSA) postarteriovenous fistula (AVF) for hemodialysis (HD). Methodology: It is a retrospective cohort study of patients on maintenance HD (MHD) who presented with PSAs post-AVF and were managed surgically from September 2021 to December 2024. Patients’ aneurysm was evaluated clinically and radiologically. The surgical management of aneurysms and outcomes was analyzed. Results: During the study period, a total of 421 patients on MHD underwent fistula creation. A total of 14 patients presented with PSA post-AVF creation. Thirty-eight percent of the patients were female and 62% were male. Twenty-one percent of cases of fistula could be salvaged. Conclusions: PSA is a known and at times devastating complication of AVF surgery. Different causes have been implicated including improper hygiene, separate foci of infection elsewhere in the body, and puncture-related complications. They are manageable with conservative treatment in early in the course, but a delayed presentation invariably needs surgical intervention of some sort. Fistula salvage is possible if the patient presents early with a stable hemodynamic condition. Arterial control and at times ligation of the arteries are required which is tolerated well by the patients. This can be done as a life-saving measure.