Aneurisms...

[Phil]

I have a fistula, and I've been told that basically the longer you are on HD the bigger your fistula gets, and eventually you can get bigger or smaller aneurisms. In my center I basically see three types of fistulas.... 1. The so called hose under your skin look 2. The hose with pronounced bumps near the needle insertion sites 3. The large tennis ball look! Having been only in place only a couple of months my fistula is still relatively unpronounced...but being new to this, and also being relativley young (29), I am worried about getting large aneurisms or the 'tennis ball fistula'. I know that estetics should be the last thing on my mind....but hey!

What I would like to understand is whether you end up with one type of fistula or the other only depends on time, or whether needle insertion techinque is a factor.

[Riki]

I've never seen the garden hose that some have talked about, but as your fistula gets used, you'll probably see the bumps around the insertion sites.  Mine has one large bump that kind of encircles both sites, but it's not really that big.  I've been using my fistula since March.

[sullidog]

The garden hose that you are talking about is a graft. It's a made of usually gortex and it joins a vaine to an artery if the person is unable to support a fistula.
Troy

[RichardMEL]

I imagine if you used buttonholes from early on the aneurysims would be less pronounced, but I've not seen any evidence of that. Yeah, my bumps are largeish but meh.. doesn't bother me. Some people have big noses. Some people have big hands (and you know what they say about people with big hands...) well I've got a big nose, big hands and big bumps!!!! The winning trifecta ladies!! 

[RightSide]

My fistula has two large bumps.  But I have been repeatedly reassured by the nurses at my center that my fistula is still working fine.

When my fistulas have failed in the past, it wasn't due to aneurysms, but to stenosis (narrowing) of the blood vessel, something which can't be seen from the outside with the naked eye.  They needed ultrasound to see that.

[Meinuk]

Fistulas can get large.  Aneurysms can get large (mine did) but that is just aesthetics, unless they become symptomatic (ditto). The symptoms are silvery thin skin, and pain.  Since mine was removed, I have been amazed at how pain free I am.  My fistula was a garden hose, and I would have kept it forever. (garden hose is good - not pretty, but good).

How your fistula looks really is based on your own physiology (how you body is), your surgeon, and the placement.  I had a Left up arm fistula that we knew would grow as the years go by, because I am a big woman (5'10"), why should my veins be small when my arms are 36" long? I also have PKD which has a co-morbidity of aneurysms, and I was at a BAD incenter clinic for 10 months before I was able to cannulate myself. All in all, a BAD combination.

An aneurysm is a weakness in the wall of a blood vessel, in the case of a fistula, in the vein that has been artificially manipulated to act as an artery close to the skin so that we can have high volume blood access for dialysis. Bad cannulation, could cause them as could just dumb luck.

Stenosis is the true enemy of fistulas as it has been said above.  Aneurysms just need to be watched.

I posted about the history of my fistula (along with photos of the beginning and end of my aneurysm), but I think that maybe we should have a fistula photo gallery.  They do come in all shapes and sizes.  EpoMan was worried that people would be scared by seeing some of the more twisted ones, but I am thinking that if we see the variety of what is out there, maybe we will become de sensitized...

Here is a link to my Fistula Post (with pictures) http://ihatedialysis.com/forum/index.php?topic=18735.0

There you go Richard.. I've shown you mine, now you show me yours!!

[Riki]

I took pictures of my fistula as well.  I try to use my blog to educate people who wouldn't know much about kidney disease, by telling my own experiences. I have pictures of my fistula after surgery, and during my first diaysis with it, and I also recorded the bruit.  I haven't taken any pictures lately.  Maybe I should.