Dialysis patients routinely undergo two fistula punctures every other day for dialysis. I will have a fistula created, typically in the arm for dialysis. This requires creating a small communication between the artery and the vein. After several years of puncture, the patients will occasionally develop a weak spot within the fistula, at the site of puncture.
This is like a hose with a weak spot that develops a bubble. This eventually will rupture. Originally, the only treatment was occlusion of the fistula. Currently, we have the option to place a "covered" stent across the pseudoaneurysm excluding it from the blood flow.
This patient was treated approximately 6 months ago and we recently had the opportunity to reevaluate her fistula. She had a large, 4 to 5 cm, pseudoaneurysm from a puncture. This was successfully excluded by the stent-graft. Follow-up today demonstrates continued good flow within the fistula and no communication with the pseudoaneurysm.