CK J R EV I EW Aneurysms and pseudoaneurysms in dialysis access

Aneurysms are a common and often difficult complication seen with arteriovenous vascular access for haemodialysis. The purpose of this narrative review is to define and describe the scale of the problem and suggested therapeutic strategies. A narrative reviewof thepublished literature illustrated by individual cases is presentedwith the aimof summarising the relevant literature. The definitions of aneurysmare inconsistent throughout the literature and therefore systematic review is impossible. They vary from qualitative descriptions to quantitative definitions using absolute size, relative size and also size plus characteristics. The incidence and aetiology are also ill defined but separation into true aneurysms and false, or pseudoaneurysmsmay be helpful in planning treatment, whichmay be conservative, surgical or radiological. The lack of useful definitions and classification along with the multitude of management strategies proposed make firm evidence based conclusions difficult to draw. Further robust well designed studies are required to define best practice for this commonproblem. Key words: arteriovenous fistula, arteriovenous graft, haemodialysis, thrombosis, ultrasonograph