Photo Quiz 7

What is this finding in a case of CKD? How will you manage this condition?

Answer:

1. This is an aneurysm in the AV Fistula which was made for hemodialysis. You can see the scar of the surgery in the typical site of a radiocephalic fistula. True aneurysms occur very commonly in native fistulas and generally cause no problems. Surgical intervention is required only if the aneurysms compromises the arterial anastomosis or shows rapid expansion raising a danger of dissection or rupture.
2. The reported incidence of this complication is around 5-6%.
3. Procedures which have been described in treating this condition are:

•  Surgical excision of the aneurysm with restoration of the continuity of the artery.
• Stapling across the aneurysm.
• Excising the excess wall and preserving the fistula.
• Excising the aneurysm and creating a new AVF

The last 2 procedures keeps the AVF intact.