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Misha Witz, Miriam Werner, Jacques Bernheim, Ali Shnaker, Jonathan Lehmann, Ze'ev Korzets, Ultrasound‐guided compression repair of pseudoaneurysms complicating a forearm dialysis arteriovenous fistula, Nephrology Dialysis Transplantation, Volume 15, Issue 9, September 2000, Pages 1453–1454, https://doi.org/10.1093/ndt/15.9.1453
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Introduction
Manual ultrasound guided compression (UGC) has become the initial treatment of choice for post‐catheterization pseudoaneurysms of the femoral artery [1–3]. However, we have found only one report of the use of this technically simple, cost‐effective procedure in the treatment of pseudoaneurysms complicating a dialysis arteriovenous fistula (AVF) in the arm [4]. We have recently successfully treated three such patients with UGC resulting in thrombosis of the false aneurysm and salvage of the vascular access. The case details and the technical aspects of the procedure are herein described.
Cases
False aneurysms developed suddenly, during or immediately following dialysis, in established AVFs in three elderly patients with atherosclerotic peripheral arterial disease. Colour duplex ultrasonography (CDU) confirmed the diagnosis. Manual pressure was applied to the pseudoaneurysms, using CDU to monitor flow in the fistulae and in the aneurysms. Pressure was maintained until the aneurysms thrombosed.
Case 1
A 72‐year‐old woman commenced haemodialysis in August 1994. In November 1994 she was started on long‐term aspirin therapy following a transient cerebral ischaemic attack. In January 1995 she developed a pseudoaneurysm of her right brachiocephalic AVF which was treated by surgical ligation with loss of vascular access. A left brachiocephalic AVF was created. In August 1998 the patient developed a pseudoaneurysm (20×15 mm) of her left AVF, presenting as a large haematoma of the upper arm at the end of a dialysis session. On this occasion, under continued aspirin therapy, UGC for 45 min resulted in complete occlusion of the pseudoaneurysm (Figures 1, 2) with preservation of access patency.
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