Repeated venipuncture as a reason of aneurysm and pseudoaneurysm of vascular access

Abstract

The most complications of the vascular access are: thrombosis, aneurysm, infection. Aneurysms can be either true, containing all layers of a venous wall, or false (pseudoaneurysm), lined by fibrous tissue and thrombosis. Aneurysm dilatation is one of the major complications of vascular access. The incidence increased with the duration of the usage, repeated puncture at the same or nearby site, and increased intraluminal pressure of the graft. We present an uncommon case in which aneurysm and pseudoaneurysm of the native fistula is caused by puncture, in both sides. Repeated punctures at the same site, may progressively weaken the venous wall resulting in dilation of the outflow vein. A 68- year-old Albanian women had been in a hemodialysis program for 4 years, using a left brachiocephalic fistula. The inflow artery, outflow vein, and the deep veins were examined in detail. During the study period the patient have had three surgeries, for aneurysm of hemodialysis access on one hand, and for pseudoanurysm of hemodialysis access on the other hand. But, even that the patient survived and everything went well. The idea of our paper was that in patients we have predisposition for the formation of aneurysm and pseudoaneursym, the medical staff have more frequent meetings, so that such cases are treated more specifically, with more frequent visits to vascular surgeon, with more frequent measurements of draining vein diameter and flow of vascular access. The K/DOQI guidelines recommend a regular program of monitoring and surveillance of the vascular access. Color Doppler ultrasound s considered a valuable tool in the preoperative evaluation and in the follow-up.