Pseudoaneurysm in PTFE Hemodialysis Graft: A Case Report

Pseudoaneurysm is a frequent late complication of expanded polytetrafluoroethylene (PTFE) hemodialysis grafts and is associated with an increased risk of rupture, infection, thrombosis, and loss of vascular access. Early diagnosis is essential to prevent severe complications, but clinical evaluation alone may be insufficient in the initial stages. We report the case of a 53-year-old woman with end-stage kidney disease secondary to lupus nephritis, on long-term hemodialysis, who developed a symptomatic pseudoaneurysm in a brachioaxillary PTFE graft four years after implantation. The patient presented with pain, swelling, and a pulsatile mass along the graft following cannulation. Point-of-care ultrasound (POCUS) performed at the dialysis unit by the attending nephrologist promptly identified a pseudoaneurysm, demonstrating an anechoic collection with luminal communication and the characteristic “yin–yang” sign on color Doppler imaging. Subsequent computed tomography angiography confirmed the diagnosis and revealed active contrast extravasation. This case highlights the critical role of POCUS in the early bedside diagnosis of vascular access complications, allowing rapid clinical decision-making and timely referral for definitive management. Incorporation of POCUS into routine dialysis practice represents a valuable strategy to improve vascular access surveillance, patient safety, and clinical outcomes.