[Digital arterial embolism after thrombosis of arteriovenous fistula]

Four patients suffering from severe digital ischemia due to emboli originating from a thrombosed arteriovenous fistula were operated on. In all cases, a large aneurysm had developed on the efferent vein. Segmental resection of the fistula and of the aneurysm with or without reanastomosis of the artery was successfully performed in all patients; a thoracic sympathectomy was performed in one because of the severity of the ischemic symptoms. Progressive degenerative changes of the arterialized vein account for the development of an aneurysm at its level with secondary thrombosis. When performing an arteriovenous fistula, end-to-end or end-to-side anastomosis of the artery prevents the occurrence of distal embolism in case of local thrombosis. Suppression of all aneurysmal fistulas is recommended whenever a kidney transplant ensures satisfactory function with sufficient follow-up.