Aneurysmal Dilatation of Dialysis Arteriovenous Access

Abstract

Arteriovenous fistula is considered the “ideal vascular access” in patients with end stage renal disease (ESRD); however, its creation is not without complications. Aneurysmal dilatation is a poorly defined complication which, can potentially lead to access loss and life threatening hemorrhage. Increased venous pressure due to proximal venous stenosis along with repeated cannulations at the same site, are thought to play a significant role in pathogenesis. Given risk of substantial bleeding, it is recommended to avoid cannulation of aneurysmal area; however, as seen in our patient significant numbers of ESRD patients are at risk of being cannulated in the aneurysmal area. Nephrologist taking care of ESRD patients should be aware of its wide clinical spectrum along with signs of “unstable aneurysms” that would mandate an emergent surgical referral. Fistulogram often identifies a high grade proximal stenosis which can be treated by percutaneous angioplasty and perhaps halt the aneurysm progression. Although, endovascular interventions with stent graft placement can be considered in those with pseudoaneurysms related to arteriovenous grafts, it is often an interim measure in an attempt to prolong access longevity. With new surgical techniques and enhanced expertise, it is now possible to salvage the current AV access while simultaneously preserving the precious venous capital for the future AV accesses.