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. 2015 Aug;8(4):363-7.
doi: 10.1093/ckj/sfv042. Epub 2015 Jun 10.

Aneurysms and pseudoaneurysms in dialysis access

Anna Mudoni  1 , Marina Cornacchiari  2 , Maurizio Gallieni  3 , Carlo Guastoni  2 , Damian McGrogan  4 , Francesco Logias  5 , Emiliana Ferramosca  6 , Marco Mereghetti  2 , Nicholas Inston  4
Affiliations

Aneurysms and pseudoaneurysms in dialysis access

Anna Mudoni et al. Clin Kidney J. 2015 Aug.

Abstract

Aneurysms are a common and often difficult complication seen with arteriovenous vascular access for haemodialysis. The purpose of this narrative review is to define and describe the scale of the problem and suggested therapeutic strategies. A narrative review of the published literature illustrated by individual cases is presented with the aim of summarising the relevant literature. The definitions of aneurysm are inconsistent throughout the literature and therefore systematic review is impossible. They vary from qualitative descriptions to quantitative definitions using absolute size, relative size and also size plus characteristics. The incidence and aetiology are also ill defined but separation into true aneurysms and false, or pseudoaneurysms may be helpful in planning treatment, which may be conservative, surgical or radiological. The lack of useful definitions and classification along with the multitude of management strategies proposed make firm evidence based conclusions difficult to draw. Further robust well designed studies are required to define best practice for this common problem.

Keywords: arteriovenous fistula; arteriovenous graft; haemodialysis; thrombosis; ultrasonography.

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Figures

Fig. 1.
Fig. 1.
Typical appearance of a longstanding mature distal radiocephalic AVF: the dilated cephalic vein is distended irregularly along its serpentine course and other draining veins are also dilated. The presence of localized aneurysmal dilatation can be seen at the sites of needling.
Fig. 2.
Fig. 2.
Pseudoaneurysm: (A) CT, (B) 3D CT reconstruction, (C) CT, (D) colour Doppler Ultrasound and angiographic images of graft rupture due to repeated localized needling and subsequent pseudoaneurysm.
Fig. 3.
Fig. 3.
Aneurysms in the site of repeated venipuncture: longstanding radiocephalic fistula with presence of aneurysms in the site of repeated venipuncture. The scares area from the needle sites are clearly visible.
Fig. 4.
Fig. 4.
A 10-year-old radiocephalic AVF: showing marked dilatation throughout but with excellent function and otherwise asymptomatic.
See this image and copyright information in PMC

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