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OBJECTIVE:
The Venous Window Needle Guide (VWING) is an implantable hemodialysis cannulation device recently FDA-approved for use on arteriovenous fistulas (AVF) which cannot be otherwise cannulated. It is a small titanium funnel, sutured directly on the vein, which provides a palpable and predictable pathway for placement of needles during hemodialysis access. We describe the first report of the development of a pseudoaneurysm associated with the use of the VWING device.
Methods:
The patient was a 55 year old obese female who had had a brachial-cephalic AVF fistula with a VWING two years previously. She presented acutely to the hospital with a painful and enlarging pulsatile mass of the AVF at the site of the VWING device placement. She was also reported to have difficulty with flows from the AVF during dialysis.
Results:
The patient underwent a fistulagram which revealed a 3.3 cm pseudoaneurysm at the inferior VWING placement site along with occlusion of the vein at the superior VWING with a branch vessel maintaining AVF patency (see image). The patient subsequently underwent surgical excision of the aneurysm. The VWING was free-floating within the pseudoaneurysm suggesting disruption of the vein by the sutures which had been attached to the VWING. A temporary dialysis catheter was placed and the patient later had creation of a new AVF in the other arm.
Conclusions:
This is the first reported case of a pseudoaneurysm associated with the VWING device, likely due to traumatic disruption of the venous wall during cannulation attempts. This complication is a potential hazard with placement of these devices and should be explained to the patients undergoing this procedure.