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AV Fistula Aneurysm Rupture Risk — ESENeph MCQ

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EasyHaemodialysisAV Fistula Aneurysm Rupture RiskESENeph

A 55-year-old man on haemodialysis via AV fistula develops a large aneurysm (5 cm) at a cannulation site. The overlying skin is thinning. What is the risk and management?

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Correct answer: C — Large aneurysms with thinning skin carry risk of rupture (potentially fatal); urgent vascular access surgical review for repair (plication, interposition graft, or excision with reconstruction) is needed

Large AV fistula aneurysms (>2x the normal vessel diameter) with thinning, shiny, or discoloured overlying skin are at risk of rupture – a life-threatening emergency. UKKA vascular access guidelines recommend urgent surgical referral for true aneurysms with skin compromise. Options include aneurysm plication (folding), interposition graft, or excision with reconstruction. Rotating cannulation sites (rope-ladder technique) prevents aneurysm formation. Buttonhole technique at the aneurysm site would increase rupture risk.

Reference: UKKA 2019 – Vascular Access; KDOQI 2019 – VA Update