Arteriovenous Fistula Aneurysm: Bench to Bedside

Arteriovenous fistula by using the native vein is the selected procedure for hemodialysis access. About 30% of this arteriovenous fistula become complicated by thrombosis, stenosis, aneurysm formation, and infection. Aneurysms can be either true (containing all layers of the vessel wall) or false, that is lined only by connective tissue. The incidence of dialysis fistula aneurysm is significant and is seen in up to 17% of AVFs and 7% of arteriovenous graft. The pathophysiology of this aneurysm is multifactorial; high fistula flow rate, venous outflow stenosis, and venous wall destruction all have been mentioned as causative factors. Venous aneurysms form due to vessel wall destruction, and as the wall stress increases, they enlarge in response to it. There are many techniques to treat these aneurysms while salvaging the arteriovenous fistula. These are aneurysmectomy with interposition grafting, endovascular stent grafting, and aneurysmorrhaphy. We reviewed 90 articles to describe the pathophysiology and different treatment modalities.