A Large Aneurysm in an Arterio-Venous Fistula for Renal Access in a Pregnant Young Woman

Stephenson, Matthew; Neate, Emily C M; Mistry, Hiren; Valenti, Domenico

doi:10.5301/jva.5000100

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…There are no data on whether aneurysm formation is accelerated in pregnant women with long-standing pre-existing AVF. One case of aneurysm formation after creation of a left brachial-cephalic fistula at 10 + 3 weeks’ gestation has been reported [ 31 ]. We identified 1 new AVF that became aneurysmal in pregnancy and was subsequently ligated without being used.…”

Section: Discussionmentioning

confidence: 99%

Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study

et al. 2022

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Background Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare. Methods Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002–2018). Results Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis. Conclusions Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study

et al. 2022

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“…Regarding patients with an AV access, an interesting case report 9 warns against the risk of development of fistula aneurysms in pregnancy, but the frequency of this complication is still unknown, and we suggest that patients already treated with an AV access should continue to do so, with careful observation of the access.…”

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confidence: 93%

Patients’ wishes, pregnancy and vascular access: When one size does not fit all

2018

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Pregnancy in dialysis patients is a rare but important event that challenges our knowledge and demands rethinking many aspects of our practice, including vascular access. This editorial briefly discusses some open questions on vascular access in this situation that challenge the motto 'fistula first' and underline the need for personalised approaches. Information on vascular access in pregnant women is scant. Different approaches may be considered between women on dialysis already on a well-functioning tunnelled catheter and newly placed catheters: while a tunnelled catheter in a woman already stabilised on outpatient dialysis, who has shown being able to take correct care of it and who has freely chosen this option, is a reasonable choice, central venous catheters placed during pregnancy, especially in the hospital setting, may have a high risk of complications. Conversely, pregnancy may increase the risk of development of fistula aneurysms, but the frequency of this complication is still unknown. The problem of whether or not shifting pregnant patients on peritoneal dialysis to daily haemodialysis sessions is still open, as well as the role of patients' preference for avoidance of an invasive procedure, or refuse of pain. In the wait for answers, reflecting on the problems encountered by pregnant women on dialysis should make us reflect on how to improve vascular access management for all our patients.

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A Large Aneurysm in an Arterio-Venous Fistula for Renal Access in a Pregnant Young Woman

Cited by 2 publications

References 9 publications

Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study

Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study

Patients’ wishes, pregnancy and vascular access: When one size does not fit all

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