Dovepress Aneurysm of the tibial-saphenous fistula in hemodialysis patient achieving patency.11 Also, Balaz et al found that to offset the weakening of the venous wall by suture following aneurys- morrhaphy, an external polyethylene terephthalate prosthesis needed to be implanted in the vein to prevent the development of intimal hyperplasia in the de novo created AV fistula.12 We did not use the external PTFE graft to protect wall weakening, because it is a foreign body that can be infected after repeated puncture, and because the vessel wall is thickened and not fragile during the operation. We have performed plication of the aneurysm in 15 patients. After surgery, the patients were observed for 39 months on average (range, 7–56 months). The patients did not suffer from any complications, including rupture and thrombosis.13 Figure 5 Anastomosis vesicle was sutured over and over with 4-0 prolene. While one patient developed thrombosis at month 4, dialysis Reported use of this type of fistula, in which anterior tibial was successful in the other two patients. Our patient underwent artery and saphenous veins are used, is limited. However, dialysis without problems for 5 years via an A-V fistula that it can be considered as an alternative approach in difficult we formed between the tibial anterior and saphenous vein, a cases. A-V fistula aneurysm is also seen on the saphenous procedure that is reported for the first time. vein, which is the alternative A-V fistula site. If a surgical Fistula aneurysm is observed as a result of collagen matrix intervention is planned for the treatment, the plication of the degeneration occurring on the vein wall. Generally, repeated aneurysm vesicle should be preferred to ligation because punctures of an A-V fistula on the same site accelerate the vein access is limited. development of an aneurysm. The potential severity of the aneurysm is high due to the risk of rupture and possibly fatal hemorrhage. Doppler USG is the gold standard in the diagnosis of A-V fistula aneurysms and in postoperative follow-up.6 We did Doppler USG to evaluate the aneurysm before the operation. For the treatment of the aneurysmal complications of arteriovenous fistulas, ligations, compression together with USG, endovascular graft implantation, or the injection of thrombin are performed.7–9 However, surgical repair is still the gold standard. In surgical treatment, ligation or the nar- rowing of the aneurysm vesicle can be performed. Lo and Tan10 reported 15 cases of uncomplicated aneurysmal dilatation of AV fistulas over a 3-year period. All underwent plication of the aneurysm. Most patients were discharged after 1 or 2 days. Only one case of postoperative complication was reported, in a patient who had superficial wound bleeding, which was stopped by adrenaline packing. Although the risk of bleeding is lower in the ligation, the fact that the fistula of the patient cannot be used a second time is a disadvantage. Moreover, for dialysis, the patient should have a double-lumen catheter. There are many complications of catheterization.10 In our patient, dialysis was carried out on the same A-V fistula 2 days after the plication procedure for a routine dialysis program. Berard et al noted that reinforced venous aneurysm- orrhaphy is effective in controlling venous dilation and Vascular Health and Risk Management 2011:7 Disclosure The author reports no conflicts of interest in this work. References 1. Gelabert HA, Freischlag JA. Hemodialysis access. In: Rutherford RB, editor. Vascular Surgery. 5th ed. Philadelphia, PA: W.B. Saunders; 2000:1466–1477. 2. Hakim R, Himmelfarb J. Haemodialysis access failure: a call to action. Kidney Int. 1998;54(4):1029–1040. 3. Pierre-Paul D, Williams S, Lee T, Gahtan V. Saphenous vein loop to femoral artery arteriovenous fistula: a practical alternative. Ann Vasc Surg. 2004;18(2):223–227. [Abstract.] 4. Chemia ES, Korrakuti L, Makanjuola D, Chang RW. Vascular Access in hemodialysis patients with central venous obstruction or stenosis: one center’s experience. Ann Vasc Surg. 2005;19(5):692–698. 5. Flora HS, Chaloner EJ, Day C, Barker SG. The ankle arterio-venous fistula: an approach to gaining vascular access for renal haemodialysis. Eur J Vasc Endovasc Surg. 2001;22(4):376–378. 6. Eugster T, Wigger P, Bölter S, Bock A, Hodel K, Stierli P. Brachial artery dilatation after arteriovenous fistulae in patients after renal transplantation: a 10- year follow-up with ultrasound scan. J Vasc Surg. 2003;37(3):564–567. 7. Gray RJ, Stone WM, Fowl RJ, Cherry KJ, Bower TC. Management of true aneurysms distal to the axillary artery. J Vasc Surg. 1998;28(4): 606–610. 8. Lin PH, Johnson CK, Pullium JK, Koffron AJ, Conklin B, Terramani TT, et al. Transluminal stent graft repair with Wallgraft endoprosthesis in a porcine arteriovenous graft pseudoaneurysm model. J Vasc Surg. 2003;37(1):175–181. 9. Clark TW, Abraham RJ. Thrombin injection for treatment of brachial artery pseudoaneurysm at the site of a hemodialysis fistula: report of two patients. Cardiovasc Intervent Radiol. 2000;23(5):396–400. 10. Lo HY, Tan SG. Arteriovenous fistula aneurysm-plicate, not ligate. Ann Acad Med Singapore. 2007;36(10):851–853. submit your manuscript | www.dovepress.com Dovepress 659