Endovascular Repair of Hemodialysis Graft-Related Pseudoaneurysm: An Alternative Treatment Strategy in Salvaging Failing Dialysis Access

Abstract

Endoluminal exclusion of AVG pseudoaneurysms using endografts is a safe and effective treatment strategy in patients with hemodialysis-related pseudoaneurysm.

Endovascular treatment of hemodialysis access pseudoaneurysms

“…14 Following the introduction of covered stent grafts, other investigators have also described their use for the treatment of hemodialysis access PSA. 3,[6][7][8]15,16 We believe our study represents the largest single institution experience that has been published to date.…”

“…6,7 In an animal model utilizing domestic swine, AVG PSAs treated with Wallgraft stents underwent dialysis by directly cannulating the PSA through the stent graft 1 week following stent graft placement and then every 4 days for 6 weeks. 8 The authors found perigraft leaks on color flow duplex scanning immediately following dialysis with leak rates decreasing from 72% to 33% from 1 to 6 weeks following endovascular treatment.…”

Stent graft treatment for hemodialysis access aneurysms

“…12,[14][15][16][17][18][19] Endovascular access aneurysm repair is usually performed as an outpatient procedure, 20 and early dialysis venipuncture is encouraged to return the patient to an uninterrupted dialysis regimen. 15,17 Although not specifically designed for hemodialysis needle puncture, commercially available covered stent devices can endure repeated punctures to extend the use of the access for hemodialysis for many years (Fig 3). 21,22 The most important factor in the progression of aneurysmal dilatation is the presence of proximal draining vein or central vein stenosis.…”

Management of hemodialysis access aneurysms and pseudoaneurysms

“…Einerseits wurden vereinzelt Fallberichte über die Kompressionstherapie [24] oder eine Thrombininjektion in den Aneurysmahals unter Ultraschallkontrolle (bei simultaner Ballonprotektion) [3] publiziert, analog zum Vorgehen nach postinterventionellen Punktionsaneurysmen femoral. Daneben finden sich auch kleinere Serien und Fallberichte über Stentgraftimplantationen zur Ausschaltung von Pseudoaneurysmen [1,7,13,20]. Vorgängig muss dabei ein Infekt zweifelsfrei ausgeschlossen werden.…”