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Case Reports
. 2018 Jul;19(4):392-395.
doi: 10.1177/1129729817747544. Epub 2018 Mar 6.

Pseudo-aneurysm caused from banding failure

Affiliations
Case Reports

Pseudo-aneurysm caused from banding failure

Alexandros Mallios et al. J Vasc Access. 2018 Jul.

Abstract

Background: To present a case of banding failure with vessel wall erosion and pseudo-aneurysm creation caused by the suture.

Case report: A 75-year-old male patient was operated for a high-flow fistula (>2 L/min). This was overall the third time that the patient was operated for the same indication since he started dialysis 5 years ago. Standard banding technique with perioperative flow measurements was used, and three separate Prolene sutures tied over 5 and 4.5 mm probes to achieve flow reduction. The operation was successful and first few weeks were uneventful. However, 5-6 weeks postoperatively, the patient felt locally an acute pain that lasted only few seconds and a voluminous aneurysm occurred progressively within the next few weeks. He was observed 2 months after the first operation where a recurrent high-flow fistula was diagnosed and ultrasound examination revealed that the sutures used for banding were into the vessel lumen while a pseudo-aneurysm had occurred at the same level. The patient was re-operated for excision of the aneurysm and flow reduction with tapering of the anastomosis.

Conclusion: Under certain conditions, the suture used for banding may erode through the vessel wall and get into the lumen. This will result in recurrence of a high-flow fistula. While this has been previously described, the phenomenon was otherwise uneventful. In contrary, in the case presented herein, a potentially threatening pseudo-aneurysm has occurred.

Keywords: AVF; Arteriovenous fistula; banding; flow reduction; pseudo-aneurysm.

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