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AV Fistula Pseudoaneurysm Emergency — ESENeph MCQ

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EasyHaemodialysisAV Fistula Pseudoaneurysm EmergencyESENeph

A 60-year-old man with CKD G5D on HD develops an AV fistula pseudoaneurysm (contained rupture with pulsatile swelling at a cannulation site, expanding rapidly). The overlying skin is intact but thinning and shiny. What is the urgent management?

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Correct answer: A — Urgent vascular surgery referral – expanding pseudoaneurysms with compromised skin require surgical repair (excision and interposition graft or direct repair); delay risks uncontrolled rupture which can be fatal

AV fistula pseudoaneurysms (false aneurysms from vessel wall disruption, unlike true aneurysms which involve all vessel layers) are surgical emergencies when expanding or when skin integrity is compromised. They result from repeated needle trauma or infection. Rupture can cause life-threatening haemorrhage. UKKA vascular access guidelines recommend urgent surgical referral. The access should not be cannulated at or near the pseudoaneurysm site. Emergency management of rupture includes direct pressure, tourniquet above the access, and emergency surgery.

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