Surgical management of a giant venous aneurysm in an autogenous arteriovenous fistula with the vessel loop shoelace technique for wound closure: A case report

Abstract

Rationale: Giant venous aneurysm (GVA) is a complication of chronic arteriovenous fistula (AVF). The risks of thrombosis, rupture, and massive hemorrhage increase with the increasing size of GVA; therefore, GVA requires treatment. However, the optimal timing and treatments are yet to be established. Patient concerns: A 51-year-old male patient who had been undergoing hemodialysis for 10 years using a left radio-cephalic AVF presented to the hospital with an enormous venous aneurysm. Diagnosis: Physical examination and ultrasound revealed a GVA in the AVF. Intervention: The aneurysm was resected, and autogenous AVF was concomitantly formed using the basilic vein. The large wound caused by the removed aneurysm defect was closed using the vessel loop shoelace technique. Outcomes: The wound healed completely, and the patient has been undergoing hemodialysis using the autogenous AVF created during the surgery for 15 months since then. Lessons: Surgical treatment should be considered for symptomatic GVA. Concomitant aneurysm resection and autogenous AVF formation using the basilic vein may be performed, and the resulting large wound can be closed with the vessel loop shoelace technique to facilitate healing.