AV Fistula Rupture Causes and Prevention

Primary Mechanisms of Rupture

The American Journal of Kidney Diseases recommends that pseudoaneurysms exceeding twice the diameter of the graft or demonstrating rapid expansion should be surgically corrected due to their increased rupture risk 5, 6
The primary cause of AV fistula rupture is aneurysm/pseudoaneurysm formation with progressive enlargement that compromises overlying skin integrity, leading to severe hemorrhage, exsanguination, and death 1, 2, 3
The mechanism of failure involves the expanding aneurysm compromising skin viability above the access, leading to incomplete hemostasis upon needle withdrawal and ultimately to graft rupture 1, 2, 3

Hemodynamically significant stenosis creates elevated pressures within the access that contribute to aneurysm formation and eventual rupture, according to the Journal of the American College of Radiology 8
Repeated needle punctures in the same location accelerate degenerative changes, increasing the risk of rupture 1, 2

Rapid expansion of aneurysm or pseudoaneurysm is a high-risk feature that indicates imminent rupture 5, 6
Skin changes, such as thinning, discoloration, or compromised integrity over the access, are warning signs of impending rupture 1, 2, 3, 7

Delaying evaluation of access dysfunction leads to thrombosis, progressive aneurysm enlargement, and ultimately rupture with catastrophic bleeding, as warned by Praxis Medical Insights 7, 9
Never cannulate through or near areas of aneurysm, pseudoaneurysm, or compromised skin, as this directly precipitates rupture 5, 6, 7, 9