초록접수 현황
| 15F-040 | 포스터 발표 |
Giant Aneurysm of a Brachiocephalic Arterio-venous Fistula Complicated with Venous Thrombosis
장지원, 김수완, 이석재, 김진식
제주대학교 의학전문대학원 제주대학교병원 흉부외과학교실
Background : Aneurysmal dilatation of arteriovenous fistula (AVF) created for hemodialysis is one of the frequently known complications. It can rupture and cause hemorrhage which could be fatal. In this case, the venous aneurysm was complicated with chronic thrombosis and resulted in edema and pain of the arm.
Methods : A 49-year-old male patient with end-stage renal disease resulting from diabetes mellitus underwent creation of a left antecubital radiocephalic AVF (side to end) for hemodialysis access ten years ago. The patient eventually noticed swelling and pain in the left forearm three years ago. The venous aneurysm was growing steadily and non-functional. The patient underwent excision of the AVF aneurysm under brachial plexus block. The incision was made at the arterial end and brachial artery control was achieved using a vessel loop (Figure A). The incision was extended as necessary during the process of excision of the aneurysmal fistula. The aneurysm measured over 10cm in it is maximal diameter. After nearly excising two thirds of the AVF aneurysm, further complete excision of the aneurysm was deferred as there was a large skin flap and to avoid flap necrosis. Excessive skin was excised and closed with tension free 3-0 Nylon sutures and a drainage catheter. The aneurysm was composed of thickened wall and filled with organized thrombi (Figure B, star marks).
Results : The patient was discharged nine days after the operation and was followed up for two months without any complications.
Conclusion : The aneurysm of the AVF can be enlarged to an extent that may cause rupture and make thrombus in the lumen. We suggest that non-functioning aneurysm of AVF should be excised, and the operation could be performed simply and safely.
Methods : A 49-year-old male patient with end-stage renal disease resulting from diabetes mellitus underwent creation of a left antecubital radiocephalic AVF (side to end) for hemodialysis access ten years ago. The patient eventually noticed swelling and pain in the left forearm three years ago. The venous aneurysm was growing steadily and non-functional. The patient underwent excision of the AVF aneurysm under brachial plexus block. The incision was made at the arterial end and brachial artery control was achieved using a vessel loop (Figure A). The incision was extended as necessary during the process of excision of the aneurysmal fistula. The aneurysm measured over 10cm in it is maximal diameter. After nearly excising two thirds of the AVF aneurysm, further complete excision of the aneurysm was deferred as there was a large skin flap and to avoid flap necrosis. Excessive skin was excised and closed with tension free 3-0 Nylon sutures and a drainage catheter. The aneurysm was composed of thickened wall and filled with organized thrombi (Figure B, star marks).
Results : The patient was discharged nine days after the operation and was followed up for two months without any complications.
Conclusion : The aneurysm of the AVF can be enlarged to an extent that may cause rupture and make thrombus in the lumen. We suggest that non-functioning aneurysm of AVF should be excised, and the operation could be performed simply and safely.
책임저자: 김수완
제주대학교 의학전문대학원 제주대학교병원 흉부외과학교실
연락처 : 김수완, Tel: 064-754-8125 , E-mail : 95swan@gmail.com
