Surgical Management and Predictive Factors of Infected Pseudoaneurysms in Native Arteriovenous Fistulas: A Four-Year Retrospective Study in Bouake

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Résumé

Introduction. Native arteriovenous fistulas (AVFs) are the preferred vascular access for chronic hemodialysis, yet their longevity is threatened by severe infectious complications. Among these, infected pseudoaneurysms represent a medical and surgical emergency affecting both life and limb prognosis. This study aimed to analyze the clinical characteristics, risk factors, and surgical outcomes of these lesions in hemodialysis patients in Sub-Saharan Africa.
Methodology. We conducted a retrospective study (2021-2024) including all patients presenting with an infected pseudoaneurysm following native AVF creation. Variables analyzed included time to onset, the iterative nature of AVF creation, surgical technique (aneurysmorrhaphy versus ligation), and postoperative outcomes. Statistical analysis was performed using SPSS version 26.
Results. Out of 285 AVFs created, 11 (3.85%) developed an infected pseudoaneurysm, predominantly in men (54.5%) with a mean age of 42.45 years. The median time to onset was 20 days, indicating early-stage complications. A salient finding shows that creating an AVF during a second iterative attempt significantly multiplied the risk of developing this complication (p < 0.001). One case of inaugural rupture was recorded. Surgical treatment, performed under local anesthesia, consisted of ligation leading to loss of vascular access in 72.7% of cases (8/11), compared to 27.3% receiving aneurysmorrhaphy to salvage the fistula. Immediate postoperative outcomes were favorable for the entire cohort, with no recurrences during follow-up.
Conclusion. Infected pseudoaneurysms occur preferentially during repeat AVF surgeries. While ligation with fistula exclusion is often unavoidable to ensure patient safety, early diagnosis may permit conservative arterial repair. Rigorous asepsis during iterative procedures is imperative to prevent this complication.

Mots-clés

Pseudoaneurysm, Infection, Arteriovenous Fistula