Comparison of aneurysmorrhaphy with and without external support for the management of arteriovenous aneurysms

Aneurysm formation is a complication of the use of arteriovenous fistulas, and symptomatic aneurysms require surgical treatment. The optimum treatment is aneurysmorrhaphy, because this salvages the function of the fistula. Aneurysmorrhaphy outcomes may be improved by implanting an external prosthesis over the repaired aneurysm. This study aimed to compare aneurysmorrhaphy performed with and without an external prosthesis.

This was a multicenter, randomized, prospective non-blinded study. Patients with symptomatic aneurysms of arteriovenous fistulas were recruited between February 2018 and September 2022. Recruited patients were assigned randomly to undergoing aneurysmorrhaphy with or without an external prosthesis. The study compared patency and aneurysm recurrence rates at 1-year follow-up.

Forty-six patients underwent aneurysmorrhaphy with an external prosthesis and fifty-five underwent aneurysmorrhaphy without an external prosthesis. There were no differences in patient and aneurysm characteristics between the two groups. At 1 year follow-up, the patency rates were 86% for aneurysmorrhaphy with external prosthesis and 80% for aneurysmorrhaphy without external prosthesis (p = 0.87). Aneurysm recurrences occurred in 2 patients (4.3%) who underwent aneurysmorrhaphy with external prosthesis and in 6 patients (10.9%) who underwent aneurysmorrhaphy without external prosthesis (p = 0.114).

There was no statistically significant difference in primary patency rates and aneurysm recurrence between patients treated with aneurysmorrhaphy with and without external prosthetic support.