BMC nephrology · 2026
Disrupted anastomotic pseudoaneurysm in arteriovenous grafts: an etiology-driven case series with a proposed preliminary management framework.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Zhou Aiqiang, Hu Liangzhu, Zi Yafei, Lu Yong, Wang Chao, He Yedong, Zhang Haihong, Deng Wei, Yu Bailin, Huang Tao, Wen Luxiang, Liu Yangdong
Аннотация
BACKGROUND: Disruption of an anastomotic pseudoaneurysm in an arteriovenous graft (AVG) is a rare but life-threatening complication in hemodialysis patients, distinct from the more common graft-body pseudoaneurysms caused by repeated needle puncture. A systematic management framework for this specific entity is currently lacking.
OBJECTIVE: To propose a preliminary etiology-based diagnostic and therapeutic conceptual framework for AVG anastomotic rupture through the analysis of three cases with different underlying mechanisms, and to explore its clinical applicability.
METHODS: We retrospectively analyzed the clinical data, imaging findings, surgical findings, and outcomes of three patients with AVG anastomotic rupture caused by trauma, degenerative changes, and infection, respectively. Based on a review of the literature, we constructed an etiology-based diagnostic and therapeutic decision-making framework grounded in a three-dimensional "localization-characterization-condition" assessment.
RESULTS: All three patients presented with pulsatile masses in the anastomotic region, and imaging studies confirmed pseudoaneurysm formation with anastomotic disruption. Individualized surgical strategies were adopted based on intraoperative etiology: direct repair was performed for traumatic rupture; autologous vein interposition grafting was employed for mechanical rupture due to tissue edema and friability; and for infectious rupture, extensive debridement combined with direct repair and complete AVG excision was undertaken. All patients recovered uneventfully and were transitioned to temporary or long-term dialysis catheters.
CONCLUSION: This preliminary framework suggests a stepwise approach to decision-making regarding treatment objectives, surgical modalities, and key technical details within a stepwise framework of emergent control versus elective planning. It highlights the potential importance of etiological prevention and correct intraoperative decision-making, and may offer a practical reference for clinical management. Further multicenter studies are required to validate its generalizability.
OBJECTIVE: To propose a preliminary etiology-based diagnostic and therapeutic conceptual framework for AVG anastomotic rupture through the analysis of three cases with different underlying mechanisms, and to explore its clinical applicability.
METHODS: We retrospectively analyzed the clinical data, imaging findings, surgical findings, and outcomes of three patients with AVG anastomotic rupture caused by trauma, degenerative changes, and infection, respectively. Based on a review of the literature, we constructed an etiology-based diagnostic and therapeutic decision-making framework grounded in a three-dimensional "localization-characterization-condition" assessment.
RESULTS: All three patients presented with pulsatile masses in the anastomotic region, and imaging studies confirmed pseudoaneurysm formation with anastomotic disruption. Individualized surgical strategies were adopted based on intraoperative etiology: direct repair was performed for traumatic rupture; autologous vein interposition grafting was employed for mechanical rupture due to tissue edema and friability; and for infectious rupture, extensive debridement combined with direct repair and complete AVG excision was undertaken. All patients recovered uneventfully and were transitioned to temporary or long-term dialysis catheters.
CONCLUSION: This preliminary framework suggests a stepwise approach to decision-making regarding treatment objectives, surgical modalities, and key technical details within a stepwise framework of emergent control versus elective planning. It highlights the potential importance of etiological prevention and correct intraoperative decision-making, and may offer a practical reference for clinical management. Further multicenter studies are required to validate its generalizability.