Chronic renal failure patients need renal replacement therapy to sustain their lives. Renal replacement therapy could be either hemodialysis (HD) or peritoneal dialysis (PD). In hemodialysis, a vascular access is created to connect the patient to the dialysis machine; the access could be a central line, a native arterio-venous fistula (AVF) or a synthetic arteriovenous graft (AVG) 1 . AVF provides the best functional patency and the least complications 1 . AVF is the recommended vascular access in patients who need dialysis treatment 2 . Nevertheless, complications, such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon 3 .A recent study on regular hemodialysis patients revealed that AVF aneurysm formation is the most common complication 3 . Background: Arterio-venous fistula (AVF) provides the best functional patency for patients onregular hemodialysis (HD). Nevertheless, complications such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon. Objective: To evaluate the trends in AVF aneurysm formations, prophylaxis and treatment options. Design: A Retrospective, Descriptive Study. Setting: Hemodialysis Centers, Ministry of Health, Kingdom of Bahrain. Method: Two hundred and eleven patients on hemodialysis via arterio-venous fistula and arteriovenous graft were included in the study. Result: Two hundred and eleven patients were on hemodialysis via arterio-venous fistula and arterio-venous graft. Thirty (14.22%) patients developed arterio-venous fistula aneurysm. Sixteen (53.33%) were males, and the mean age was 57 years. Eleven (36.66%) patients had excision of the aneurysms with interposition graft. Six (20%) patients had excision of the aneurysms with new fistula formation. Six (20%) patients required a change of the cannula insertion site while the remaining 7 (23.33%) patients were waiting for their scheduled date of surgery. Conclusion: Aneurysm formation is the most common complication in post AVF patients on regular HD. AVF aneurysms are at high risk of rupture and fatal hemorrhage. Surgical treatments could safely be performed for high risk aneurysms. The most common cause of aneurysm formation is repeated punctures at the same site.

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