Novel treatment of a totally occluded venous outflow tract of an arteriovenous graft

The Journal of Vascular Access
Crystal A FarringtonAmmar Almehmi

Abstract

Conventional guidewire techniques are not always sufficient to restore arteriovenous graft patency in patients with challenging vascular scenarios. We discuss a novel approach to the treatment of chronic total occlusion of the venous outflow tract to enable successful arteriovenous graft thrombectomy. A 28-year-old female with end-stage renal disease on chronic hemodialysis and recurrent arteriovenous graft thromboses presented with a clotted thigh graft. An existing ipsilateral common femoral vein stent was found to be chronically occluded, causing persistent venous outflow obstruction and rendering an initial attempt at thrombectomy unsuccessful due to wire buckling and the inability to navigate through the stent chronic total occlusion. After establishing femoral vein access, a vibrational recanalization device was used to cross the occluded stent. The device was then removed, permitting routine angioplasty. Post-angioplasty angiogram revealed persistent intra-stent stenosis, so a covered stent was deployed with good angiographic results. Routine pharmaco-mechanical thrombectomy of the arteriovenous graft was then performed. Two additional stents were placed due to stenotic recoil in the venous limb of the graft. Angioplasty...Continue Reading

References

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