case: dialysis graft thrombectomy + outlet jump graft revision

dialysis graft outlet stricture

jump graft revision of the outlet

History:
A patient of ESRD on regular dialysis. The dialysis graft is on his left upper arm. He had received dialysis graft outlet patch revision some one month ago. Repeated graft thrombosus had brought him to surgery.
Operation finding:
Left upper arm brachial-axillary graft total thrombosis with the graft outlet severe stenosis.
Operation stratagy:
In addition to the thrombectomy of the graft, underlying stricture of the vessel must be addressed in order to keep a good operation result.(as the DOQI guideline said) Thus I attacked the dialysis graft outlet stenosis directly and explored the more proximal axillary vein. Once I have found the suitable new venous outlet, I put in a segment of ePTFE jump graft for a bypass.( in this case, a cuffed graft) The bypass graft had created a smooth and wide open graft outlet and thus prevent further thrombosis episode hopefully.
The thrill of the dialysis was fair after the procedure. And the patient had been put on dialysis via the original graft immediately after the operation.