AV fistula aneurysm/pseudoaneurysm: Difference between revisions
(Created page with "==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...") |
Neil.m.young (talk | contribs) (Text replacement - "Pts " to "Patients ") |
||
| (5 intermediate revisions by 3 users not shown) | |||
| Line 9: | Line 9: | ||
==Clinical Features== | ==Clinical Features== | ||
* | *Patients will have physical findings of a dilated aneurysm | ||
*Bleeding | *Bleeding | ||
*Eschar | *Eschar | ||
*Mostly asymptomatic | *Mostly asymptomatic | ||
==Differential Diagnosis== | |||
{{AV shunt complications DDX}} | |||
==Management== | ==Management== | ||
*Depends if | *Depends if patient is symptomatic | ||
*AV Fistula: indications for vascular evaluation | *AV Fistula: indications for vascular evaluation <ref>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.</ref> | ||
**The skin overlying the fistula is compromised | **The skin overlying the fistula is compromised | ||
**There is a risk of fistula rupture | **There is a risk of fistula rupture | ||
**Available puncture sites are limited | **Available puncture sites are limited | ||
*AV Graft: indications for vascular evaluation | *AV Graft: indications for vascular evaluation<ref>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.</ref> | ||
**Pseudoaneurysm that is symptomatic | **Pseudoaneurysm that is symptomatic | ||
**Pseudoaneurysm that is twice the diameter of the graft (ie, >4 cm in diameter) | **Pseudoaneurysm that is twice the diameter of the graft (ie, >4 cm in diameter) | ||
| Line 43: | Line 40: | ||
==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Renal]] | [[Category:Renal]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
Latest revision as of 20:29, 11 July 2016
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
- Aneursym: contains all layers of the vessel wall
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 [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