Flow-targeted lumen remodeling with aneurysmectomy in salvage of dysfunctional arteriovenous fistula: a case report

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.