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

• Clotting of AV fistula
• Infection of AV fistula
• Hemorrhage of AV fistula
• Vascular insufficiency from AV fistula
• AV fistula aneurysm/pseudoaneurysm
• High-output heart failure from AV fistula

Management

• Depends if patient is symptomatic

• AV Fistula: indications for vascular evaluation
  • 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
  • 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

• Dialysis complications

References

Authors

Michael Hwang, Ross Donaldson, Neil Young