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The natural history of aneurysms in VA is poorly defined, and although classifications exist they are not uniformly applied in studies or clinical practice. True and pseudo aneurysms of AV access occur. Whilst an AV fistula by definition is an abnormal dilatation of a blood vessel, an agreed definition of 18 mm, or 3 times accepted maturation diameter, is proposed. The mechanism of aneurysmal dilatation is unknown but appears to be a combination of excessive external remodeling, wall changes due to injury, and obstruction of outflow. Diagnosis of AV aneurysms is based on physical examination and ultrasound. Venography and cross-sectional imaging may assist and be required for the investigation of outflow stenosis. Treatment of pseudo aneurysms and true aneurysms of VA (AVA) is not evidence-based, but relies on clinical experience and available facilities. In many AVA, a conservative approach with surveillance is suitable, although intervals and modalities are unclear. Avoidance of rupture is imperative and preemptive treatment should aim for access preservation, ideally with avoidance of prosthetic materials. Different techniques of aneurysmorrhaphy are described with good results in published series. Although endovascular approaches and stenting are described with good short-term results, issues with cannulation of stented areas occur and, while possible, this is not recommended, and long-term access revision is recommended.<\/jats:p>","DOI":"10.5301\/jva.5000828","type":"journal-article","created":{"date-parts":[[2017,11,3]],"date-time":"2017-11-03T10:24:30Z","timestamp":1509704670000},"page":"464-472","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":55,"title":["Aneurysms in Vascular Access: State of the Art and Future Developments"],"prefix":"10.1177","volume":"18","author":[{"given":"Nicholas","family":"Inston","sequence":"first","affiliation":[{"name":"Department of Renal Surgery and Vascular Access, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiren","family":"Mistry","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King's College Hospital, Denmark Hill, London - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kingsmore","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery and Renal Surgery, Queen Elizabeth University Hospital, Glasgow - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahid","family":"Raza","sequence":"additional","affiliation":[{"name":"Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Tozzi","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Department of Surgery and Center for Research on Organ Transplantation, Insubria University School of Medicine, Circolo University Hospital, Varese - Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Azizzadeh","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas - USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Renal Surgery and Vascular Access, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Deane","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King's College Hospital, Denmark Hill, London - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Wilkins","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King's College Hospital, Denmark Hill, London - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingemar","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tulane University, New Orleans, Louisiana - USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ross","sequence":"additional","affiliation":[{"name":"Dialysis Access Institute, Orangeburg Regional Medical Center, Orangeburg, South Carolina - USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King's College Hospital, Denmark Hill, London - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Valenti","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King's College Hospital, Denmark Hill, London - UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,2,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/17.6.1057"},{"issue":"1","key":"e_1_3_2_3_2","first-page":"519","article-title":"Venous aneurysm complicating arteriovenous fistula access and matrix metalloproteinases.","volume":"10","author":"Serra R","year":"2015","unstructured":"SerraR ButricoL GrandeR et al. 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