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
- 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