Late occurrence of a large brachial artery aneurysm following closure of a hemodialysis arteriovenous fistula.

After the pioneer observations by Hunter more than two centuries ago, recent reports have expanded our knowledge about the occurrence and pathophysiology of arterial abnormalities associated with long-lasting hemodialysis arteriovenous fistula (AVF) after its closure. Observed abnormalities include arterial dilatation and aneurysm formation proximal to the site of the repaired AVF. We describe here a patient who developed, after long-lasting hemodialysis AVF, a pan-arterial dilatation with a large brachial artery aneurysm, which was successfully treated with a polytetrafluoroethylene bypass graft.

Major vessel injuries during laparoscopic cholecystectomy: a case report.

The aim of the study was to investigate major vascular injury during laparoscopic cholecystectomy, which is a rare but potentially lethal complication if not recognized and treated swiftly, usually secondary to placement of the Veress needle or trocar. We report on our experience with a 35-year-old woman presenting an aortic laceration of the anterior wall and a puncture wound penetrating the anterior wall of the inferior vena cava. Repair of the injuries was done using a 5-0 Prolene suture mounted on pledgets. In addition, it was necessary to suture three mesenteric vascular injuries in the posterior peritoneum with Vicryl 2-0. The estimated blood loss was 1300 cc. The patient did well and was discharged on postoperative day 13. The distal abdominal aorta, inferior vena cava and large pelvic vessels are particularly prone to injury during laparoscopic cholecystectomy. In most cases, the vascular defect can be closed by direct suturing. Rarely is it necessary to reconstruct the injured vessel with an alloplastic prosthetic patch or a prosthetic implant.