Vascular Health and Risk Management Open Access Full Text Article Dovepress open access to scientific and medical research C A S E R E P O R T Aneurysm of the tibial-saphenous fistula in hemodialysis patient: the results of surgical treatment Murat Günday Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, Trabzon, Turkey Correspondence: Murat Günday Başkent University, Department of Cardiovascular Surgery, Konya, Turkey, 42100 Tel +90 0 506 59573 02 Fax +90 332 257 06 37 Email gundaymurat@yahoo.com submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/VHRM.S23963 Abstract: Arteriovenous fistulas are widely used for hemodialysis patients with end-stage renal failure. Due to the lack of suitable veins because of the arteriovenous fistulas previously opened in the upper extremity, alternative access routes are being tested. Few complications of long-term alternative arteriovenous fistulas have been reported in the literature. We report the results of surgical repairs of aneurysms that occurred on anterior tibial-saphenous arteriovenous fistulas (along the vein) in patients with end-stage renal disease after 5 years on hemodialysis. Keywords: vascular access, aneurysm, saphena magna, renal failure, long term Introduction Generally, arteriovenous (A-V) fistulas are performed in the veins of the upper extremity and in the non-dominant arm. Brescia–Cimino fistulas are the gold standard as an access route during hemodialysis.1 In patients that undergo dialysis repetitively, the fistula located in the wrist becomes obstructed over time and the patient cannot undergo dialysis from this same point. In such situations, it is preferred to form a new fistula or to use polytetrafluoroethylene (PTFE) graft.2 Another method is to form alternative access routes.3 For A-V fistulas, the most common complication is aneurysmal degeneration, which is seen in the late stage, and which appears like a true or false aneurysm. In this study, we report an A-V fistula aneurysm that was developed as an alternative to an A-V fistula between the anterior tibial artery and saphenous vein, a site not commonly reported in the literature, also the surgical treatment that we performed. Case report The 35-year-old female patient had previously repeatedly had A-V fistulas constructed on both upper extremities. Double-lumen catheters had been placed repeatedly in subclavian veins on both sides prior to the construction of A-V fistulas in her upper extremity. Allografts had been taken out from upper extremities because of graft infec- tion. Bilaterally axillar veins were occluded. As there were no eligible veins to form a fistula in the upper extremity, surgery had been performed 5 years ago on the right lower extremity, between the anterior tibial artery and saphenous vein. The patient presented to our out-patient department complaining of ballooning on the saphenous vein for about a year and especially a foot pain that had recently started to appear after walking. The patient’s physical systemic examinations were normal. A strong thrill could be obtained on the aneurysm (Figure 1). The pulse on the anterior tibial artery showed a weakening compared with the other foot. Preoperative Vascular Health and Risk Management 2011:7 657–660 © 2011 Günday, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 657