Trauma-Induced Pseudoaneurysm of Hemodialysis Arteriovenous Fistulae: A Case Series and Surgical Management Outcomes

Background: An Arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing long-term haemodialysis due to its durability and lower complication rates compared to other access modalities. However, AVFs remain susceptible to trauma-related complications. Traumatic injury to a mature AVF can result in pseudoaneurysm formation, which carries risks of rupture, infection, thrombosis, and potential loss of vascular access. Literature describing trauma-induced AVF pseudoaneurysms remains limited.

Methods: We report a case series of three patients with established upper-limb AVFs who developed pseudoaneurysms following blunt traumatic injury. Clinical presentation, fistula characteristics, surgical management, and postoperative outcomes were evaluated.

Results: All three patients presented with localized swelling over the AVF site after traumatic insult. Imaging confirmed pseudoaneurysm arising from the fistula tract. The configurations involved included brachiocephalic and brachiobasilic AVFs. Given the risk of rupture and progressive enlargement, surgical exploration was undertaken in all cases. Intraoperatively, pseudoaneurysms originating from the fistula segment were identified. Excision of the pseudoaneurysm was performed, followed by ligation and closure of the affected fistula. All patients had an uneventful postoperative recovery without procedure-related morbidity.

Conclusion: Traumatic injury to hemodialysis AVFs can result in pseudoaneurysm formation, a potentially limb- and life-threatening complication. Early diagnosis and timely surgical intervention are critical to prevent catastrophic outcomes. Surgical excision with fistula ligation is a safe and effective management strategy in selected cases. This series underscores the importance of patient education regarding fistula protection and vigilance following trauma