Abstract

Introduction: Pseudo aneurysms occur due to injury to arterial wall. Due to sustained arterial pressure, blood dissects into the tissues around the damaged artery and forms a perfused sac that communicates with the arterial lumen. The perfused sac contains media or adventitia or simply soft tissue structures surrounding the injured vessel. Material and Methods: We analysed 32 patients who underwent surgical AVF takedown after formation of pseudo aneurysm at our centre over a period of 3 years between September 2018 to September 2021. Results: 32 patients (26 males and 6 females) underwent takedown of AVF during this 3 years period. 22 (84.62%) had fistula on their left arm as compared to 4 (15.38%) having fistula on their right arm. 21 (80.76%) were brachiocephalic fistulas while the remaining 5 (19.24%) were radio cephalic. 25 (78.12%) presented as pseudo aneurysms with a risk of impending rupture, while 7 (21.88%) presented with aneurysmal rupture. 14 (43.75%) underwent the procedure under axillary block, 18 (56.25%) were operated under local anaesthesia and minimal sedation. Mean operative time was 75.72 ± 24.27 min. 26 (81.25%) underwent excision of aneurysm with ligation of proximal and distal end of arteries while 6 (18.75%) underwent arterial reconstruction with venous interposition grafting. Mean duration of hospital stay was 3.4 days with a maximum of 7.2 days. 6 of our patients had post op wound infection. All patients had good distal pulsations in the postoperative period. Conclusion: Pseudo aneurysms pose threat to both limb and life. Planning is necessary for properly managing these patients. Though surgical excision of aneurysm with reconstruction of vessel has remained definite treatment for impending and ruptured Pseudo aneurysms, however in our experience most of our patients didn’t need reconstruction as collaterals had already formed and no patient had post operative ischemia after proximal and distal ligation of artery along with excision of aneurismal tissue.

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