Long-Segment Plication Technique for Arteriovenous Fistulae Threatened by Diffuse Aneurysmal Degeneration: Short-term Results Alexis Powell, 1 Mathew Wooster, 1 Megan Carroll, 1 Damian Cardentey-Oliva, 1 Sean Cavanagh-Voss, 1 Paul Armstrong, 1 Murray Shames, 1 Karl Illig, 1 and Wesley Gabbard, 2 Tampa, Florida Background: A substantial number of patients with autologous arteriovenous fistulas (AVFs) develop diffuse aneurysmal degeneration, which frequently interferes with successful ac- cess. These AVFs are often deemed unsalvageable. We hypothesize that long-segment plication in these patients can be performed safely with acceptable short-term AVF salvage rates. Methods: We reviewed a prospectively maintained database to identify all patients with exten- sive AVF aneurysmal disease operated on for this problem. Results: Thirty-five patients, 25 (71%) male and 10 (29%) female were operated on between July 2012 and January 2014. AVFs included 23 (66%) brachiocephalic, 5 (14%) radioce- phalic, and 7 brachiobasilic (20%) fistulae (one first stage only but in use). The cohort had one or a combination of local pain, arm edema, cannulation issue, recurrent thrombosis, dysfunctional during dialysis, or extreme tortuousity. Time range for AVF creation to consul- tation ranged from 3 months to 11 years. All underwent long-segment plication over a 20-Fr Bougie with or without segmental vein resection; 3 underwent concomitant first rib resection for costoclavicular stenosis; 21 patients had tunneled catheter placement for use while heal- ing, whereas 13 were allowed segmental use of their AVF during the perioperative period (1 patient was not yet on dialysis). Early in our experience, AVFs were left under the wound, whereas all but one repaired since early 2013 were left under a lateral flap. All patients were followed by clinical examination and duplex. In the 30-day postoperative period, 2 AVFs (5.7%) became infected requiring excision, 2 occluded (5.7%), 1 day 1 and the other at 24 days out, 1 patient developed steal and required DRIL 1 week postoperatively, and 1 patient died, unrelated to his surgery. Postoperative functional primary patency was 88% (30 of 34). Of the patients needing temporary access catheter, mean time to first fistula use was 44 days. No wound or bleeding complications have occurred in repaired AVF left under skin flaps. Conclusions: In this group of patients whose access was threatened by diffuse aneurysmal degeneration, long-segment placation allowed salvage of 88% of fistulae with relatively low morbidity. Fewer complications are associated by covering the revised fistula with intact skin. 1 Division of Vascular Surgery, University of South Florida, Tampa, FL. 2 Tampa Bay Vascular Center, Tampa, FL. Correspondence to: Alexis Powell, MD, Division of Vascular Surgery, Department of Vascular Surgery, University of South Florida, 2A Tampa General Circle, 7th Floor, Tampa, FL 33606, USA; E-mail: apowellr@gmail.com Ann Vasc Surg 2015; 29: 1327–1331 http://dx.doi.org/10.1016/j.avsg.2015.02.004 Ó 2015 Elsevier Inc. All rights reserved. Manuscript received: October 28, 2014; manuscript accepted: February 13, 2015; published online: March 11, 2015. 1327