Risk Factors and Clinical Insights: Aneurysm Management in Native Arteriovenous Fistulas Before Chronic Hemodialysis

Introduction: This study identifies fistulized renal patients likely to develop this type of postoperative complication in order to improve their treatment. Material & Methods: This was a cross-sectional study of patients with arteriovenous fistula who were received for Arteriovenous Aneurysm (AVA) in the main Emergency Medical Care and Assistance Services (SAMU) of Abidjan (University Hospital of Cocody, Yopougon, and Treichville) between March 2014 and February 2018 and of Bouaké from March 2018 to September 2021. We recorded epidemiological, clinical, and biological data for each AVA carrier, HIV seroprevalence, surgical procedures, and postoperative. Results: 2013 NAVF were collected with 117 AAV (5.9%) during this period. The mean age was 42.30 years ± 13.31 years [extremes: 11 years and 75 years], and the sex ratio (M/F) was 2.36. The age range of 10 years to 50 years represented 68.38%. 52.14% of patients developing AVA were unemployed or were working in the informal sector. HIV seroprevalence was 11.97%. The main cardiovascular risk factor was hypertension (84.11%). The mean pre- hospital renal clearance was 39.7 ml/min ± 1.2 ml/min [extremes: 17 ml/min and 91 ml/min]. NAVF was located mainly in the left forearm (86.09%). AVAs were located at the site of the NAVF (69.23%) and at the site of puncture of the arterialized vein (30.77%), with a mean time of occurrence of 18.14 months ± 12 months. False aneurysms and true AVAs, respectively, represented 17.09% and 82.91%. Fifty patients underwent reoperation for an AVA. Surgery consisted of total aneurysmectomy (n = 41), initial removal of the NAVF followed by immediate remote NAVF reconfection (n = 10), and secondary (n = 31). The mean duration of hospitalization was 6.13 ± 4.49 hours [extremes: 0.5 and 78 hours]. The loss of sight rate was 4.5%. Immediate postoperative complications of AVA (34%) were due to fistulous hyper flow syndrome (n = 7), surgical wound suppuration (n = 4), AVA recurrence (n = 2), severe anemia, and hemorrhage (n = 4). Immediate postoperative mortality was 18% versus 10.30% with surgical abstention (p = 0.48).According to the pathological anatomical aspect of the arteriovenous lesion in our study, the predictor of reoperation was HIV seropositivity adjusting for false arteriovenous aneurysms HRa = 3.098; CI95 [1.3217–7.2647], p = 0.0008