left upper arm dialysis graft occlusion
severe intimal hyperplasia caused stricture of vessel lumen
Patch angioplasty to augment the lumen
History:
A patient of ESRD on regular dialysis. Acute thrombosis of her left upper arm graft was noted 3 days ago and emergent thrombectomy was performed. Unfortunately, recurrent thrombosis was noted right after the surgery. She was scheduled for recannalization of the graft.
Operative finding:
The patient's left upper arm dialysis ePTFE graft was total thrombosed. The graft outelt was explored directly and severe intimal hyperplaia of the graft-venous junction was noted. Apparently, the hyperplasia had lead into severe stenosis of the outflow tract thus in turn caused the graft repeated thrombosis.
My operative strategy:
In addition to the thrombectomy of the graft using Fogarty thrombectomy catheter, I had to treat the graft outlet stenosis as well to keep the graft open. Due to the focal stricture which was less than 2 centimeter in length, I have decided to put a ePTFE patch on the outflow tract to augment the size of the vessel.
After the procedure, the thrill on the graft was rather easy and vivid to palpate. She was sent to the dialysis room after the procedure and receive the dialysis treatment via the graft.
29 Jan 2007
case: dialysis graft thrombectomy + outlet patch revision
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