title: True aneurysm in autologous hemodialysis fistulae: definitions, classification and indications for treatment.
abstract: BACKGROUND
  Definition, etiology, classification and indication for treatment of the arteriovenous access (AVA) aneurysm are poorly described in medical literature. The objectives of the paper are to complete this information gap according to the extensive review of the literature.
  
  
  METHODS
  A literature search was performed of the articles published between April 1, 1967, and March 1, 2014. The databases searched included Medline and the Cochrane Database of Systematic Reviews. The eligibility criteria in this review studies the need to assess the association of aneurysms and pseudoaneurysms with autologous AVA. Aneurysms and pseudoaneurysms involving prosthetic AVA were not included in this literature review. From a total of 327 papers, 54 non-English papers, 40 case reports and 167 papers which did not meet the eligibility criteria were removed. The remaining 66 papers were reviewed.
  
  
  RESULTS
  Based on the literature the indication for the treatment of an AVA aneurysm is its clinical presentation related to the patient's discomfort, bleeding prevention and inadequate access flow. A new classification system of AVA aneurysm, which divides it into the four types, was also suggested.
  
  
  CONCLUSIONS
  AVA aneurysm is characterized by an enlargement of all three vessel layers with a diameter of more than 18 mm and can be presented in four types according to the presence of stenosis and/or thrombosis. The management of an AVA aneurysm depends on several factors including skin condition, clinical symptoms, ease of cannulation and access flow. The diameter of the AVA aneurysm as a solo parameter is not an indication for the treatment.
authors.affiliation: Department of Transplantation, Renal Unit, Guy's Hospital, London - UK.|Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague - Czech Republic.|Department of Surgery, Faculty Hospital Kralovske Vinohrady, 3 Medical Faculty, Charles University, Prague - Czech Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Balaz
authors.affiliation: Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala - Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Björck
mesh_terms: D000783:Aneurysm / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017541:Aneurysm, False / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D004108:Dilatation, Pathologic; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome