title: Massaging thrombosed PTFE hemodialysis access graft - recipe for disaster.
abstract: Early thrombosis of a polytetrafluoroethylene (PTFE) graft used for hemodialysis vascular access can result from technical error or hypotension and hypovolaemia in the immediate postoperative period. Massaging a graft to dislodge a freshly formed thrombus with a view to restoring blood flow can lead to acute limb ischaemia from embolisation of the artery as a result of migration of the thrombus from the arterial end of the graft, hence massaging of thrombosed grafts should be avoided. This report describes the management of a 35-year-old diabetic male who developed acute ischaemia of hand due to embolisation of the radial artery following massage of a thrombosed brachio-basilic forearm PTFE loop graft.
authors.affiliation: Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK. shresthabm@doctors.net.uk
authors.forename: B M
authors.initials: BM
authors.lastname: Shrestha
mesh_terms: D000208:Acute Disease; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D004617:Embolism / Q000150:complications / Q000209:etiology; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000209:etiology* / Q000628:therapy; D006225:Hand / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008405:Massage / Q000009:adverse effects*; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000379:methods*; D013927:Thrombosis / Q000150:complications / Q000209:etiology* / Q000628:therapy
chemical_list: D011138:Polytetrafluoroethylene