Why does the vessel in my arm keep getting bigger with dialysis?
Aneurysm of the access vessel is a question that concerns many dialysis patients and nurses.
Many people worry that the aneurysm will keep growing and may rupture or bleed. What should be done, and what causes it?
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Aneurysm is one of the common vascular complications in dialysis patients.
Patients are advised to keep an eye on the vessel in their arm and to return for regular follow-up and vessel checks to prevent the aneurysm from enlarging rapidly.
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Causes
Needle punctures: repeated needling and changes in blood flow injure the vessel; a more fragile vessel is more likely to form an aneurysm.
Vessel stenosis: if the vessel is narrowed and flow is impaired, long-term pressure and high flow lead to dilation and deformation of the vessel.
High blood pressure: high blood pressure increases the pressure on the vessel wall and promotes aneurysm formation.
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Principles of treatment
Monitoring and early detection: regularly check the size and location of the aneurysm so that problems are found early.
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Blood pressure control: keep blood pressure well controlled to reduce the pressure on the vessel wall.
Minimally invasive endovascular treatment: for vessel stenosis, balloon angioplasty or stent placement is used to improve blood flow and reduce the risk of aneurysm.
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Appropriate needling technique: using a regular, dispersed multi-site pattern of needling (left in the figure below) rather than irregular repeated puncture at the same spot (right in the figure) reduces the occurrence of aneurysm.
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Surgical treatment: when the aneurysm enlarges and becomes dangerous, surgical excision or reconstruction is needed.
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Clinical case shared by our team (July 2024)
A patient’s native-vessel aneurysm in the arm was gradually enlarging. An aneurysm near the elbow was surgically excised, and the vessel was reconstructed in place.
The day after surgery the patient dialyzed normally through the native arm vessel, with no need for a neck dialysis catheter.
More about aneurysms of the dialysis access:
References
KDOQI Clinical Practice Guidelines for Vascular Access, 2019 Update⋯⋯. National Kidney Foundation.
Vascular Access Work Group, “Clinical Practice Guidelines for Vascular Access,” American Journal of Kidney Diseases, vol. 48, no. 1, 2006, pp. S176-S247
