View source for 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==
*Pts will have physical findings of a dilated aneurysm
*Bleeding
*Eschar
*Mostly asymptomatic

==Management==
*Depends if pt is symptomatic

*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
**There is a risk of fistula rupture
**Available puncture sites are limited

*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 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]]

==External Links==

==Sources==
<references/>

[[Category:Renal]]
[[Category:Vascular]]