Surgical management of a ruptured basilic vein aneurysm

A 60-year-old female with dialysis-dependent end-stage renal failure presented at the study centre complaining of acute pain in the right arm at the level of her brachio-basilic arteriovenous fistula. The basilic vein was aneurysmal at the level of the dialysis puncture site (panel A). Under general anaesthesia, brachial artery control proximal to the fistula was established and the brachio-basilic anastomosis was exposed; when clamping the basilic vein it was noted to have ruptured (panel B). The aneurysmal segment of basilic vein was removed with primary closure of the anastomosis preserving the patency of the brachial artery, with no neurovascular complications.