Case study: Stentgrafting for dialysis graft outlet stenosis

History

A patietn of ESRD on regular dialysis vie her left upper arm graft. graft outlet segmental stricture was noted and the stenosis was refratory to repeated PTA (percutaneous balloon angioplasty).

Operative finding

During the venography study, graft outelt segmental stricture was noted. Due to the elasticity of the stricture, definite treatment is needed.

Strategy

Definite repair of the outlet stricture was needed. The options were:

1. Surgical revision, which is more invasive and time consuming. In addition, the lesion extended up to the high axillary vein make the revision more difficult. General anesthesia was needed to do the jump graft revision which will add on more anesthesia risk.

2. PTA with stent insertion. Covered-stent insertion over the stricture segment can prohibit immediate recoil and may prevent recurrent stricture in the long run. In addition, it's only a percutaneous procedure which is low risk to the patient. Thus we had proceed with covered-stent implantation to deal with the graft outlet recurrent stricture.