Single-stage aneurysmorrhaphy, downstream venous plication and external PTFE reinforcement for multiple true aneurysms in a high-flow brachiocephalic arteriovenous fistula: A case report

True aneurysms of a haemodialysis arteriovenous fistula (AVF) and a co-existent high-flow state pose a particular surgical problem, because the structural and the haemodynamic abnormality must be corrected at the same operation if a precious native access is to be preserved. We report a 51-year-old woman maintained on thrice-weekly haemodialysis through an 18-month-old left brachiocephalic AVF, who developed two cephalic-vein true aneurysms (2.48 and 2.14 cm) in the outflow segment with an access flow of 6.7 L/min,(peak-systolic-velocity-based duplex estimate).concentric left-ventricular hypertrophy and grade 3 diastolic dysfunction Through a single incision we performed partial-wall aneurysmorrhaphy of both sacs, deliberate downstream venous plication for flow reduction, and circumferential external polytetrafluoroethylene (PTFE) reinforcement of the entire repaired and plicated segment, with intraoperative duplex titration of the haemodynamic endpoint. Access flow fell from 6.7 to 1.4 L/min (≈79% reduction) with preserved patency. The combined approach delivers structural repair, mechanical reinforcement and flow modulation in one stage and avoids prosthetic interposition, separate arterial dissection and prolonged catheter dependence.