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Updated: Dec 3, 2025

Author Spotlight: Investigating Wound Healing in Mice Models of Oronasal Fistulas

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Mega Fistulae! A case series.

Ali I Gardezi¹, Mustafa Mawih¹, Ezzideen B Alrawi¹

¹Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

The Journal of Vascular Access

|October 27, 2020

Summary

This summary is machine-generated.

Mega fistulae, or enlarged arteriovenous fistulae, can cause serious complications. Regular access surveillance is crucial, especially for non-dialysis patients, to prevent these issues and preserve vascular access.

Keywords:

Mega fistula aneurysm angioplasty arteriovenous fistula ligation venous stenosis

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Published on: November 23, 2017

Area of Science:

Interventional Nephrology
Vascular Surgery
Dialysis Access Management

Background:

Mega fistulae are characterized by generalized aneurysmal dilatation of arteriovenous fistulae.
These enlarged fistulae can lead to severe complications including high-output cardiac failure, steal syndrome, skin ulceration, and rupture.

Purpose of the Study:

To evaluate the characteristics and management outcomes of mega fistulae in patients referred to an interventional nephrology practice.
To investigate the role of unrecognized outflow stenosis in mega fistula formation.
To emphasize the importance of continuous access surveillance.

Main Methods:

Retrospective review of ten patients with mega fistulae.
Analysis of fistula type, patient history (pre-transplant/post-transplant), outflow stenosis, and treatment interventions.
Assessment of surveillance practices.

Main Results:

Nine patients were post-transplant; one was pre-dialysis.
All patients, except one, had severe outflow stenosis, commonly at the cephalic vein at the elbow or cephalic arch.
Half of the patients had chronic total occlusion of the outflow vein. Successful angioplasty was achieved in only two patients; seven underwent ligation.

Conclusions:

Unrecognized and uncorrected outflow stenosis is a significant factor in mega fistula development.
Ligation is often the only treatment option for established mega fistulae, leading to loss of vascular access.
Continuous surveillance of vascular access, even in non-dialysis patients, is vital for preventing mega fistula complications.