True aneurysms of the upper extremity arteries are quite rare, usually associated with trauma or infection. Arterial aneurysmal degeneration could also occur proximally to arteriovenous hemodialysis access, a complication that has been reported more frequently. This study aims to clearly define the anatomical characteristics and natural history of true arterial aneurysms associated with hemodialysis arteriovenous access.

We performed a systematic review of the literature in the MedLine, Scopus, and Cochrane databases from 1991 to 2021. Cases of pseudoaneurysms and anastomotic aneurysms were excluded. A total of 47 articles referring to 98 patients were included. Demographic characteristics, particularities of vascular access, symptoms, treatment, and follow-up were analyzed.

Most patients included were male (85%) with a mean age of 51 years (range 20-77 years). The most frequently affected artery was the brachial artery in 87% of cases (n=86), with the axillary and radial arteries being less affected. The vascular accesses frequently associated were autologous radiocephalic arteriovenous fistulas in 57% (n=56) and brachycephalic fistulas in 39% (n=38). Most patients had a history of kidney transplantation (88%; n=86) and previous vascular access ligation or thrombosis (84%; n=82). The median time from access ligation to aneurysm diagnosis was 10 years (range 1-32 years) and the median time from kidney transplantation was 13 years (range 1-32 years). Only 8% of patients (n=8) had a history of diabetes mellitus. Treatment was open surgery with interposition bypass or end-to-end reconstruction in most cases, and endovascular treatment was only reported in one patient to repair a ruptured axillary artery aneurysm. The median reported patency time was 12 months (range 1-72 months).

Aneurysmal degeneration of the inflow artery proximal to the hemodialysis vascular access must be understood as an individualized entity with specific characteristics. Aneurysm degeneration usually affects the brachial artery after kidney transplant and is associated with wrist fistulas after ligation of the vascular access. Although diabetes is a significant cause of kidney disease, this group of patients is rarely affected. Our review suggests that donor artery aneurysm degeneration screening with ultrasound should be considered 10 to 15 years after access ligation and kidney transplant.