Vascular access related aneurysms in patients on maintenance hemodialysis

Abstract

Background and Aims: Arterio-venous (AV) access has been considered as an Achilles heel in the management and outcomes of End Stage Renal Disease (ESRD) patients on Maintenance Hemodialysis (MHD). Vascular Access Related Aneurysms (VARA) significantly impact the functional status of the AV access and thus affects the patients' outcomes. Our study was taken up in this context. This study was conducted to decipher the anatomical, functional, imaging, complications and management aspects of VARA. Methods: A cross-sectional, observational study was done on 429 patients of ESRD on MHD in our institute. The clinical aspects, demographics, imaging aspects were stressed followed by management. Both descriptive and inferential statistics were used and aP value <0.05 was considered as significant. Results: Total number of study participants were 429. Of them, 48 patients developed AVF aneurysms (11.1%). The mean age of the patients was 52.9 years with a male: female ratio of 34: 14. Majority of them were ESRD due to diabetic nephroathy (62.5%). Morphologically majority of them were saccular (69%) while rest of them were fusiform (31%) None of our patients had downstream stenosis, and thrombus was seen in 5 patients (10.4%), complications secondary to rupture of AVF with hemorrhage, was seen in 6.25% (n = 3). Conclusions: We found VARA in 11.6% of our MHD population predominantly in men, in their middle age. They were more common in diabetic ESRDS. Aneurysmal rupture was seen in 6.25%. Our study highlights the importance of periodic evaluation for aneurysms and necessary management.

Keywords

• arteriovenous fistula (avf) complications
• maintenance hemodialysis
• vascular access related aneurysms