Abstract
We report a rare case of pseudoaneurysm of arteriovenous fistula which could be treated by patch-angioplasty using a PTFE graft wall. A 41-year-old woman on chronic hemodialysis was referred to our hospital complaining of an enlarged pulsatile mass with pain in the left upper arm. Ultrasonography revealed the presence of a 40-mm aneurysm of the vein of arteriovenous fistula. Considering the risk of aneurysmal rupture, we performed aneurysmectomy. After removing the pseudoaneurysm completely, a perforating hole, 30 mm in size, on the anterior wall of the shunt vein was identified. The venous wall around the hole appeared firm without any atherosclerotic changes or infectious sign, so we performed patch-closure with trimmed PTFE graft wall. Postoperative contrast computed tomography (CT) showed stenosis of the left subclavian vein, suggesting a cause associated with possible postoperative swelling of the left upper arm. After the patient underwent percutaneous angioplasty, swelling of the left upper arm was improved gradually. The patient has been doing well nine months after the treatments.
