Variant 10: Abnormal skin changes associated with the upper or lower extremity hemodialysis access cannulation site, including marked thinning, ulceration, eschar formation, spontaneous bleeding, pseudoaneurysm formation, superficial or deep infection. Treatment and procedures. Fluoroscopy Fistulography Hemodialysis Access with Intervention In cases of suspected superficial or deep infection, there is no evidence to support fluoroscopic fistulography of the hemodialysis access with endovascular intervention. Vascular surgical consultation is supported to evaluate the need for surgical revision. Dialysis Fistula Malfunction In the setting of pseudoaneurysm formation at the hemodialysis access cannulation site without suspicion for infection, fluoroscopic fistulography with endovascular intervention may have a limited role in treatment. There have been several small retrospective and prospective nonrandomized studies suggesting the viability of endovascular treatment of the cannulation site pseudoaneurysms using endovascular stent grafts [124-126]. In a retrospective study of 24 patients with a pseudoaneurysm treated with endovascular stent grafts, Shah et al [124] reported an overall patency rate of 81.5% with a mean follow up of 268.9 days and a treatment failure rate of 18.5%. Of the 5 patients with treatment failure, 3 underwent surgical repair due to graft infection. A retrospective review of 38 endovascular stent placements for treatment of a pseudoaneurysm and stenosis found a complication rate of 28.9%, with a relative risk ratio of 5 for stent graft placement for the treatment of a pseudoaneurysm compared to for a stenosis alone [127]. Fluoroscopic fistulography of the hemodialysis access with endovascular intervention has been considered as an option prior to surgical repair of an aneurysm or pseudoaneurysm to evaluate and treat an underlying venous outflow stenosis that may be a precipitator of the associated aneurysm or pseudoaneurysm [123].
Dialysis Fistula Malfunction. Variant 10: Abnormal skin changes associated with the upper or lower extremity hemodialysis access cannulation site, including marked thinning, ulceration, eschar formation, spontaneous bleeding, pseudoaneurysm formation, superficial or deep infection. Treatment and procedures. Fluoroscopy Fistulography Hemodialysis Access with Intervention In cases of suspected superficial or deep infection, there is no evidence to support fluoroscopic fistulography of the hemodialysis access with endovascular intervention. Vascular surgical consultation is supported to evaluate the need for surgical revision. Dialysis Fistula Malfunction In the setting of pseudoaneurysm formation at the hemodialysis access cannulation site without suspicion for infection, fluoroscopic fistulography with endovascular intervention may have a limited role in treatment. There have been several small retrospective and prospective nonrandomized studies suggesting the viability of endovascular treatment of the cannulation site pseudoaneurysms using endovascular stent grafts [124-126]. In a retrospective study of 24 patients with a pseudoaneurysm treated with endovascular stent grafts, Shah et al [124] reported an overall patency rate of 81.5% with a mean follow up of 268.9 days and a treatment failure rate of 18.5%. Of the 5 patients with treatment failure, 3 underwent surgical repair due to graft infection. A retrospective review of 38 endovascular stent placements for treatment of a pseudoaneurysm and stenosis found a complication rate of 28.9%, with a relative risk ratio of 5 for stent graft placement for the treatment of a pseudoaneurysm compared to for a stenosis alone [127]. Fluoroscopic fistulography of the hemodialysis access with endovascular intervention has been considered as an option prior to surgical repair of an aneurysm or pseudoaneurysm to evaluate and treat an underlying venous outflow stenosis that may be a precipitator of the associated aneurysm or pseudoaneurysm [123].