ArticleJournal of cardiothoracic surgery2026
Flow-targeted lumen remodeling with aneurysmectomy in salvage of dysfunctional arteriovenous fistula: a case report.
Article in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aneurysmal dilation represents a complex complication of arteriovenous fistulas (AVF) with significant clinical implications including high-output heart failure and functional impairment. We report a 46-year-old male with end-stage renal disease who developed maximum diameter 40 mm aneurysmal dilation of the cephalic vein 42 months after brachiocephalic fistula creation, with flow volume reaching 2,680 mL/min. We employed an innovative flow-targeted lumen remodeling technique combined with aneurysmectomy, utilizing computational fluid dynamics modeling to achieve optimal hemodynamic control. Using a 20Fr silicone catheter as an intraluminal template, the venous diameter was precisely reduced from 35 mm to 7 ± 1.0 mm, successfully decreasing flow volume to 850 mL/min. The patient resumed dialysis within 24 h postoperatively without requiring central venous catheterization. Three-month follow-up demonstrated sustained functional patency with maintained flow volume of 880 mL/min and normal venous pressure. This technique represents a paradigm shift in complex vascular access salvage, offering superior outcomes compared to conventional methods while preserving autogenous access and avoiding prosthetic materials.
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