AV fistula aneurysm/pseudoaneurysm

Background
  • AV fistulas/grafts can form a aneurysm or pseudoaneurysm which can lead to bleeding and other complications
    • Aneursym: contains all layers of the vessel wall
      • Most are asymptomatic; rarely rupture
      • More likely in fistula than grafts
    • Pseudoaneurysm: focal disruption of vessel wall with a collection of blood that is contained
      • Results from subcutaneous extravasation of blood from puncture sites
      • More likely in grafts than fistulas

Clinical Features
  • Patients will have physical findings of a dilated aneurysm
  • Bleeding
  • Eschar
  • Mostly asymptomatic

Differential Diagnosis

AV Fistula Complications

Management
  • Depends if patient is symptomatic
  • AV Fistula: indications for vascular evaluation [1]
    • The skin overlying the fistula is compromised
    • There is a risk of fistula rupture
    • Available puncture sites are limited
  • AV Graft: indications for vascular evaluation[2]
    • Pseudoaneurysm that is symptomatic
    • Pseudoaneurysm that is twice the diameter of the graft (ie, >4 cm in diameter)
    • Pseudoaneurysm that threatens the viability of the overlying skin, regardless of diameter
    • Pseudoaneurysm that is expanding
    • Large or multiple pseudoaneurysms that limit the number of cannulation sites.

Disposition
  • Likely discharge home with vascular consultation

See Also

References
  1. Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17:S1.
  2. Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17:S1.
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