Abstract
The incidence of aneurysms of arteriovenous fistula in haemodialysis patients is reported to be as high as 60%. Although the clinical presentation of arteriovenous fistula aneurysm is often asymptomatic, symptomatic cases should be associated with serious complications.
Despite the development of various surgical and endovascular procedures to treat arteriovenous fistula aneurysms, clinical guidelines are limited in terms of when and how to intervene. The objective of this chapter is to discuss the definition, aetiology, classification, clinical presentation, indications and methods for treatment of arteriovenous fistula aneurysm.
The authors' experience and a non-systematic literature review of articles published between January 1973 and June 2016 were used as the source of information for this chapter. Databases searched include Medline, Science direct, Scopus and the Cochrane Database of Systematic Reviews.
Eligibility criteria were aneurysm of arteriovenous fistula and treatment techniques. Information regarding aneurysms and pseudoaneurysms involving prosthetic arteriovenous access were not included in this chapter.
Indications for treatment of arteriovenous fistula aneurysm are patient discomfort, bleeding prevention and low or high flow. The diameter of the arteriovenous fistula aneurysm is not a sole indication for treatment.
The most frequently used techniques for treating arteriovenous fistula aneurysm are resection with interposition, remodelling and stentgraft implantation. Arteriovenous fistula aneurysm is characterized by an enlargement of all three vessel layers to a diameter of more than 18 mm.
In asymptomatic aneurysms, conservative treatment is recommended. The main indications for treatment of a symptomatic aneurysm are patient discomfort, bleeding prevention and low or high flow.
The diameter of an arteriovenous fistula aneurysm and cosmetic issues should not be used as the sole indications for treatment. Although various surgical and endovascular techniques have been described, no prospective comparative study between these techniques exists and no particular method is recommended.