Günday Dovepress Figure 1 The aneurysm on saphenous vein. laboratory findings showed no pathologic evidence, except a lowered hematocrit value. Blood pressure (120/80 mmHg) was normal. The patient underwent a venous Doppler ultra- sonography (USG) of the lower extremity in the radiology department. The aneurysm (45 × 30 mm) was detected in Doppler USG (Figure 2). The patient was taken into the operating room. A tourniquet was put on at the popliteal level. After administering local anesthetic, the aneurysm was opened on the vesicle. Subcutaneous tissue was gently dissected and bleeding was controlled from the proximal and distal aneurysm sides (Figure 3). The patient was given 5000 U heparin. After ensuring the resolution of thrill on the vesicle by tightening the tourniquet at 200 mmHg, venotomy was performed. The anastomotic region was narrowed with a purse suture using 4-0 prolene (Figure 4). Approximately 0.5–2 cm was cut from each side of the opened vein. The anastomosis vesicle was sutured over and over with 4-0 prolene (Figure 5). The diameter was reduced to approximately 0.5–1 cm. A strong thrill was palpated on the aneurysm. The patient was discharged on the same Figure 3 The bleeding was controlled from the proximal and distal aneurysm sides. day and underwent dialysis from the same vein 2 days later. Low-molecule-weight heparin was used during the first dialysis after the surgical repair of the aneurysm. During follow-ups in the outpatient department, aspirin was given. It was observed that the patient’s complaints about foot pain on walking had lessened. Discussion The types of alternative A-V fistulas include saphenofemoral and saphenopopliteal loop fistulas, transposition of femoral vein to popliteal artery, axillary artery-popliteal vein PTFE bypass,4 posterior tibial artery-saphenous vein fistula,5 and femoro-femoral loop fistula. Pierre-Paul et al3 did a sapheno-femoral loop graft on seven patients. Perioperative acute occlusion or steal syndrome was not observed. Mean duration of primary patency was found to be 7 months. In the hemodialysis, 71.4% of the aneu- rysm fistulas (5/7) were functional. Six patients showed mild or moderate leg edema that required the use of compression socks. In another study, a tibial post-saphenous vein fistula was formed on 3 patients, who were followed-up over 12 months.5 Figure 2 The aneurysm is seen in Doppler ultrasonography. Figure 4 The anastomotic region was narrowed with a purse suture using 4-0 prolene. 658 submit your manuscript | www.dovepress.com Dovepress Vascular Health and Risk Management 2011:7