关键词: 自体动静脉内瘘动脉瘤, 动脉瘤部分切除术, 玻璃样变性, 黏液样变性

Abstract: Background　By 2019，there have been 600 000 patients with maintenance hemodialysis （MHD） registered in China，and more than 80% of them had autologous arteriovenous fistula （AVF）.As aterial-venouse fistula aneurysm （AVFA） is one of the most common complications of AVF，the study of AVFAs is helpful for its prevention and control.Objective　To track the AVFAs recurrence in AVF patients and to explore its association with AVFAs histopathology based on studying the histology of the diseased blood vessels removed during partial aneurysmectomy of AVFAs，to formulate corresponding feasible prevention and control measures.Methods　A total of 13 cases of complex AVFAs were reconstructed with partial aneurysmectomy from April 2016 to October 2019 in Hainan Genenral Hospital.The resected vascular tissue 〔with a size of （5-10） mm×（5-10） mm〕 was used for pathological analysis.The changes of the AVFAs were followed up.Results　The surgeries were successful for all 13 patients.During the follow-up of 3-39 〔average （22.4±11.9）〕 months，seven were found with AVFAs relapse within 3-6 months after surgery，but 12 had a patent fistula.Pathology results:vascular endothelial cells were significantly reduced or absent；fibroblasts and collagen tissue of the vascular intima and media showed proliferation and were disordered，the inner and outer elastic layers were incomplete or absent，and few reticular and elastic fibers were present；and few or no smooth muscle cells were present.The aneurysm wall showed large-scale hyaline degeneration in all 13 patients，which has never been reported before.In particular，the whole section of the vascular wall was involved in 10 patients，with scattered mucoid degeneration and focal calcification mixed or alone.AVFAs recurred during follow-up in 6 patients with hyaline degeneration involving the entire cross section of the resected blood vessel.Conclusion　Partial aneurysmectomy for AVFAs is effective at preventing vascular rupture and preserving vascular resources.Diverse degeneration patterns，including severe hyaline degeneration，mucoid degeneration，and focal calcification of intraoperative use of AVF vessels，especially continued cannulation in the reconstructed area，may easily induce AVFAs to relapse.Buttonhole cannulation may reduce the incidence of AVFAs and reccurence ratio after partial aneurysmectomy.Early local compression of the aneurysm can delay the development of AVFAs and reduce the need for invasive surgery.Larger-scale studies of AVFAs histology，comparison studies of the effects of different AVF cannulation methods on the incidence of AVFAs，and studies on the profile of AVFAs disease-related genes are needed.

Key words: Autologous arteriovenous fistula aneurysm, Partial aneurysmectomy, Hyaline degeneration, Mucoid degeneration