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HOW TO USE

When the arterialized aneurysmatic vein is disconnected from the artery and dissected carefully up to the healthy non-aneurysmal zone, the surrounding tissues must be removed from the vein. After this, the first part (tubus) of the BalRok clamp is inserted into the lumen of the vein. The second part of the clamp is then placed over the aneurysm, connected with the first part of the clamp and the aneurysmal sac is resected with a scalpel. The second part of the BalRok clamp is then removed and finally the vein is sutured by a continuous running stitch with atraumatic 6/0 suture thread over the tubus (first part) of the BalRok clamp. The diameter of the tubus (5,6,7 mm) depends on the external prosthesis which will be used for vein protection (the prosthesis must be oversided by 1mm more than the diameter of the tubus). For detailed instructions see the video.

 


REFERENCES

Repair of Aneurysmal Arteriovenous Fistulae: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg. Baláž P, Rokošný S, Bafrnec J, Whitley A, O'Neill S. 2020;59(4):614–623. doi:10.1016/j.ejvs.2019.07.033

Contemporary management of arteriovenous hemodialysis fistula aneurysms. Rokosny S, O’Neill S, Balaz P. Cor et Vasa 2018, 60(1):e49-e55, doi:10.1016/j.crvasa.2017.10.005

Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease. Wohlfahrt P, Rokosny S, Melenovsky V, Borlaug BA, Pecenkova V, Balaz P. Hypertens Res. 2016;39(9):654–659. doi:10.1038/hr.2016.50

True aneurysm in autologous hemodialysis fistulae: definitions, classification and indications for treatment. Balaz P, Björck M. J Vasc Access. 2015;16(6):446–453. doi:10.5301/jva.5000391

Reinforced Aneurysmorrhaphy for True Aneurysmal Haemodialysis Vascular Access.
Rokošný S, Baláž P, Wohlfahrt P, Palouš D, Janoušek L. Eur J Vasc Endovasc Surg. 2014, doi: 10.1016/j.ejvs.2014.01.010

Aneurysmorrhaphy is an easy technique for arteriovenous fistula salvage. Balaz P, Rokosny S, Klein D, Adamec M. J Vasc Access. 2008 Apr-Jun;9(2):81-4.