Preservation of vascular access in aneurysmal native fistulas: Ten years of stapled aneurysmoplasty

Abstract

Introduction: Aneurysmal degeneration of autogenous arteriovenous fistulas represents an increasingly prevalent complication in long-term dialysis patients, often leading to access failure and significant morbidity. Despite the clinical relevance, consensus on optimal surgical management remains limited.

Methods: We present a 10-year single-center experience with a modified stapling technique for AVF aneurysmoplasty, aimed at preserving native access while enabling immediate post-operative cannulation. This retrospective analysis includes 184 patients undergoing reconstruction for AVF aneurysms between 2014 and 2024.

Results: Technical success was achieved in 95.7% of cases, with early cannulation feasible in 91.6% of patients. The early failure rate was 2.3%. Primary patency at 1, 3, 5, and 10 years was 91.3%, 87.8%, 80.8%, and 22.6%, respectively; cumulative functional patency was 94%, 91.1%, 83.6%, and 30.5%. Recurrence was observed in 15.2% of cases, strongly associated with high-flow AVFs and central venous stenosis. Targeted intraoperative flow improved outcomes in anatomically complex cases.

Conclusions: Stapled aneurysmoplasty is a safe and durable option for AVF reconstruction, with high success and patency rates. Preoperative flow assessment and individualized hemodynamic correction are crucial to long-term outcomes. In cases of recurrence, conversion to graft-based access may be warranted. These findings support a native access-preserving approach in suitable patients.

Keywords: AV fistula; Doppler evaluation; aneurysm; dialysis; dialysis access; techniques and procedures; ultrasonography.