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The creation and preservation of vascular accesses, in patients with end-stage renal failure, remains a challenge for nephrologists and vascular surgeons. Native fistula is the best vascular access, humeral-basilic fistula is a precious access in patients who have exhausted their venous capital in the forearm and in whom the cephalic vein of the arm is small or damaged. Given its deep location, any puncture of this vein is prohibited before its superficialization, even if it is of good caliber, because it can have dramatic consequences, in particular the loss of the limb or even death. We report the case of a patient undergoing hemodialysis for seven years with a non-superficialized humeral-basilic fistula, admitted for an iatrogenic false aneurysm of the brachial artery following a puncture for dialysis, with compression of the median nerve, treated surgically.

Native arteriovenous fistula is the best available vascular access for hemodialysis in end-stage renal failure. It is characterized by higher patency rates and lower rates of morbidity, mortality and complication compared to prosthetic bypass grafts and central venous catheters. Aneurysmal complications remain the main complications of these access with a high risk of rupture and fatal hemorrhage. Their management varies from case to another and several methods are reported in the literature. We describe a case of an atypical localization of a juxta-anastomotic venous aneurysm in the anatomical snuffbox, treated by resection with proximal reimplantation of the cephalic vein at the wrist.

Introduction Subclavian steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery. Materials and methods Four patients with subclavian steal syndrome were treated in our center. Percutaneous radial approach was used for angioplasty, primary stenting of subclavian artery was performed, surgical techniques in particular carotid-subclavian bypass and carotid-subclavian transposition were used. Results We report the cases of four patients, three of which are male, with an average age of 60 years. All of them were symptomatic. Diagnosis was made by duplex ultrasound, supplemented by CT-angiography and arteriography. Endovascular treatment was attempted in all four patients, which was successful in two patients, who underwent primary stenting, and failed for the two others, for whom surgical treatment was considered. One had a subclavio-carotid bypass graft with a polytetrafluorethylene (PTFE) prosthesis and the other had a subclavio-carotid transposition. The technical results were satisfactory in all patients with symptoms resolution. The postoperative evolution was without notable complications and the postoperative checkups were satisfactory. Discussion There are excellent screening tools and effective medical therapies which can be instituted if the SSS is diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness. Nevertheless, large, prospective, randomized and controlled trials are needed to compare the long-term patency rates between the endovascular and surgical techniques., Highlights • SSS is caused by the reversal of blood flow in the vertebral artery. • Doppler ultrasound is the ultimate screening tool for diagnosis. • Treatment of symptomatic SSS is always indicated. • Endovascular approach is the first-line treatment.

The creation and preservation of vascular accesses, in patients with end-stage renal failure, remains a challenge for nephrologists and vascular surgeons. Native fistula is the best vascular access, humeral-basilic fistula is a precious access in patients who have exhausted their venous capital in the forearm and in whom the cephalic vein of the arm is small or damaged. Given its deep location, any puncture of this vein is prohibited before its superficialization, even if it is of good caliber, because it can have dramatic consequences, in particular the loss of the limb or even death. We report the case of a patient undergoing hemodialysis for seven years with a non-superficialized humeral-basilic fistula, admitted for an iatrogenic false aneurysm of the brachial artery following a puncture for dialysis, with compression of the median nerve, treated surgically.

Le cathétérisme de la veine jugulaire interne est pratiqué largement, aussi bien par les néphrologues que par les chirurgiens, il est devenu une procédure de routine, mais qui peut être associée à de graves complications. La fistule artério-veineuse carotido jugulaire (FCJ) est une complication rare mais potentiellement fatale. Très peu de cas sont rapportés dans la littérature. Nous présentons un cas unique d´un patient avec une FCJ iatrogène, suite à une pose de cathéter d'hémodialyse trois semaines auparavant. Le diagnostic est suspecté cliniquement par la découverte de thrill latéro cervical, et confirmé à l´echodoppler et à l´angiographie. Le patient a eu une cure chirurgicale ouverte avec succès. L'expérience de l´opérateur et l´accompagnement des jeunes internes, en plus de l'utilisation du guidage échographique peut réduire considérablement la survenue de complications lors du cathétérisme veineux jugulaire.

Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.

Native arteriovenous fistula is the best available vascular access for hemodialysis in end-stage renal failure. It is characterized by higher patency rates and lower rates of morbidity, mortality and complication compared to prosthetic bypass grafts and central venous catheters. Aneurysmal complications remain the main complications of these access with a high risk of rupture and fatal hemorrhage. Their management varies from case to another and several methods are reported in the literature. We describe a case of an atypical localization of a juxta-anastomotic venous aneurysm in the anatomical snuffbox, treated by resection with proximal reimplantation of the cephalic vein at the wrist.

Resume Introduction Les anevrismes de l’artere hepatique sont rares. Le diagnostic est souvent fait au stade de rupture, avec une importante mortalite. Observations Une patiente âgee de 70 ans souffrait de vomissements et de douleurs de l’hypocondre droit. A l’echographie, un anevrisme asymptomatique de l’artere hepatique a ete diagnostique. Le traitement a consiste en une mise a plat de l’anevrisme suivi d’un pontage splenohepatique droit avec une evolution postoperatoire satisfaisante. Le second cas concerne un patient de 54 ans, pour lequel le diagnostic d’un anevrisme de l’artere hepatique droite a ete fait au stade de rupture dans la vesicule biliaire. Discussion A la lumiere de ces 2 cas et des donnees de la litterature, nous analysons l’incidence, les causes, les moyens diagnostiques et therapeutiques de cette affection.

Gluteal artery aneurysms are rare and mostly secondary to blunt or penetrating trauma. As an absolute rarity, we report an exceptional presentation of bilateral mycotic aneurysm of the superior gluteal artery in a 16-year-old boy associated with bacterial endocarditis. The left pseudoaneurysm was ruptured and treated using open surgery; 1 week later, the right location was successfully treated by embolization.

Aneurysms of the hepatic artery are relatively rare. Diagnosis often occurs only after rupture, and mortality is substantial. We report two new cases.The first patient was a 70-year-old woman whose asymptomatic aneurysm of the common hepatic artery was identified during ultrasound for vomiting and abdominal pain. Open aneurysm repair and a hepatosplenic bypass led to a favorable outcome. The second patient was a 54-year-old man; his right hepatic artery aneurysm was diagnosed after it ruptured in the gall bladder.We review the literature about hepatic artery aneurysms and discuss the clinical features and methods for diagnosis and treatment of these uncommon lesions.