Principles of treating enlarging pseudoaneurysm in a dialysis arteriovenous graft.

The arteriovenous graft (AVG) is one of the major types of permanent vascular access used to provide hemodialysis. Complications encountered with AVG use include stenosis, infection, thrombosis, and pseudoaneurysm formation. Venous outflow stenosis along with frequent needle cannulation at the same site can lead to breakdown of the graft material, resulting in pseudoaneurysm formation. In the following case, we illustrate common management principles used to treat pseudoaneurysms. While stent-grafts have been utilized for pseudoaneurysm repair, stent-graft usage is not always optimal. Surgical management may be an ideal choice of treatment. The role of educating the dialysis staff and patients is essential to identify and minimize the risk of pseudoaneurysm formation.