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Patient with loop-configuration PTFE hemodialysis graft presents with severe pain and ecchymosis of her left forearm PowerPoint Presentation
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Patient with loop-configuration PTFE hemodialysis graft presents with severe pain and ecchymosis of her left forearm - PowerPoint PPT Presentation


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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 . Active extravasation from the arterial limb

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Presentation Transcript
slide1

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

slide2

Active extravasation from the arterial limb

due to traumatic needle cannulation

slide3

9 Fr. introducer sheath

stent graft (7mm)

Using an angioplasty balloon to seal the ends

of a 7mm x 4cm stent graft

slide6

Pre-PTA

Post-PTA

slide9

Patient returns three weeks later with development

of small pseudoaneurysm arising from venous limb;

the previous site of insertion of 8 Fr vascular sheath

slide11

pseudoaneurysm

venous

stenosis

pseudoaneurysm

slide12

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