Upload
ivy-cervantes
View
39
Download
2
Tags:
Embed Size (px)
DESCRIPTION
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 - PowerPoint PPT Presentation
Citation preview
Patient with loop-configuration PTFE hemodialysis graftpresents 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 limbdue to traumatic needle cannulation
9 Fr. introducer sheath
stent graft (7mm)
Using an angioplasty balloon to seal the endsof a 7mm x 4cm stent graft
Following deployment of stent graft
The patient also had a venous anastomotic stenosis
Pre-PTA
Post-PTA
Duplication of left basilic veins
Left central veins
Patient returns three weeks later with developmentof small pseudoaneurysm arising from venous limb;the previous site of insertion of 8 Fr vascular sheath
pseudoaneurysm
venousstenosis
pseudoaneurysm
pseudoaneurysm
The development of the small pseudoaneurysmis likely due to continued elevation of intragraft pressure
from the persistent venous anastomotic stenosis.
The pseudoaneurysm is located at the site of insertionof the large diameter (8 Fr) vascular sheath which was
used during insertion of the stent graft for repair of theacute injury in the arterial limb of the graft.
The patient is schedule to undergo surgical revisionof the venous anastomotic stenosis in 9 days.
this should reduce the intragraft pressure and removethe impetus for further enlargement of the pseudoaneurysm