Patient with loop-configuration PTFE hemodialysis graft

1
Patient with loop-configuration PTFE hemodialysis
graft presents with severe pain and ecchymosis of
her left forearm
Earlier today the dialysis nurse had difficulty
when cannulating the arterial limb of her graft
2
Active extravasation from the arterial limb due
to traumatic needle cannulation
3
9 Fr. introducer sheath
stent graft (7mm)
Using an angioplasty balloon to seal the ends of
a 7mm x 4cm stent graft
4
Following deployment of stent graft
5
The patient also had a venous anastomotic stenosis
6
Pre-PTA
Post-PTA
7
Duplication of left basilic veins
8
Left central veins
9
Patient returns three weeks later with
development of small pseudoaneurysm arising from
venous limb the previous site of insertion of 8
Fr vascular sheath
10
pseudoaneurysm
11
pseudoaneurysm
venous stenosis
pseudoaneurysm
12
The development of the small pseudoaneurysm is
likely due to continued elevation of intragraft
pressure from the persistent venous anastomotic
stenosis.
The pseudoaneurysm is located at the site of
insertion of the large diameter (8 Fr) vascular
sheath which was used during insertion of the
stent graft for repair of the acute injury in the
arterial limb of the graft.
The patient is schedule to undergo surgical
revision of the venous anastomotic stenosis in 9
days. this should reduce the intragraft pressure
and remove the impetus for further enlargement of
the pseudoaneurysm