Introduction: A native arteriovenous fistula remains the best option for dialysis access in chronic kidney disease. With prolonged use many of them are prone to develop pseudoaneurysms. Various treatment options in the past have been suggested including ligation, endovscular stenting, and replacement with a prosthetic graft. We describe a new technique of excision of pseudoanerysmal wall, followed by reconstruction of native fistula and transposition.

Methods: Twenty two adult hemodialysis dependent patients have undergone this procedure. Surgery is performed under general anesthesia. The arteriovenous fistula is dissected along its entire length. Excessive anuerysmal wall is excised and the luminal integrity of fistula is restablished with a nonabsorbable suture. The blood flow is restablished and hemostasis is ensured. A new subcutaneous pocket is created over the lateral and superficial aspect of the extremity and the reconstructed fistula is transposed using open technique. Most were performed as an out patient procedure. The patients recieved hemodialysis through a temporary central venous catheter while the fistula healed. All reconstructed fistulae were used after three to four weeks.

Results: With an average follow up of 9 months, twenty one of twenty two fustulae are functioning. Excellent blood flows have been reported during hemodialysis. One fistula clotted on postoperative day 14 and was lost due to noncompliance. Two patients had superficial partial skin necrosis and healed within three weeks with a functioning fistula.

Conclusion: With this technique, we have been able to salvage native arteriovenous fistulae avoiding the use of long term central venous catheters and prosthetic grafts.