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Abstract: FR-PO576

Case of Acute Pseudo-Aneurysm Formation in a Clotted and Abandoned Brachial-Cephalic Arteriovenous Fistula

Session Information

Category: Trainee Case Report

  • 704 Dialysis: Vascular Access

Authors

  • Mariuma, David, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Shaikh, Aisha, James J. Peters Medical Center VA, Bronx, New York, United States
Introduction

Pseudo-aneurysm formation is a known complication of dialysis arteriovenous access. Pseudo-aneurysms typically form at the site of needle puncture or at the arteriovenous anastomosis. Here we present a case of acute pseudo-aneurysm formation in a clotted and abandoned arterio-venous fistula (AVF)

Case Description

An 88-year old male on chronic hemodialysis via a right femoral vein catheter presented to the dialysis unit with sudden onset of swelling in his left arm. The swelling was in the ante-cubital fossa, near the arteriovenous anastomosis of a clotted left arteriovenous fistula (AVF) that had not been cannulated in over 6 years. He denied any trauma at the site of the swelling and attested to a significant increase in the size of the swelling over the past 48 hours. On examination the swelling was firm, pulsatile and non-tender. Vascular surgery was consulted, and same day intra-operative findings confirmed the presence of a pseudo-aneurysm which was resected. The histology and cultures of the resected tissue did not reveal any malignancy or infection

Discussion

Pseudo-aneurysms are hematomas that form due to a defect in the vessel wall. They are devoid of the endothelium or the vessel wall. In other words, they are hematomas communicating with the lumen of the vascular access, and therefore rupture of a pseudo-aneurysm can be life-threating. Typically, the pseudo-aneurysms form at the site of repeated needle cannulation. Pseudo-aneurysm formation is very rare in a clotted or abandoned AV access. It is not clear what caused the pseudo-aneurysm formation in this patient, but this case highlights the importance of continued monitoring of ‘abandoned and clotted’ dialysis vascular access