Six years after heart transplantation a 56-year-old patient with renal insufficiency required a Cimino fistula in the right forearm. Three-and-a-half years later a rapidly growing venous aneurysm of the fistula required surgical revision. The skin incision was made along the whole length of the aneurysmal vein (Fig 1a). The arteriovenous anastomosis was separated and the venous aneurysm incised longitudinally. Using a 7 mm Hegar’s dilator, a venous tube was created by oversewing the aneurysmal wall with running 6-0 Prolene sutures. The venous tube was then inserted into an highly flexible metal mesh tube, and the two joined with fibrin glue. Finally, the arteriovenous anastomosis was re-established (Fig 1b). The braided metal mesh tubing was Fig. 1. (a) The venous aneurysm has rapidly developed 3.5 years after the installation of an arteriovenous fistula for haemodialysis. made of stainless steel with 48 wires of 36 micron (b) The biocompound-graft consists of a venous tube from the aneurysmatic wall wrapped with an ultraflexible metal mesh. ∗ Please address all correspondence to: O. Grauhan, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.