title: Endovascular treatment of stent fracture and pseudoaneurysm formation in arteriovenous fistula dialysis access.
abstract: Arteriovenous fistulae (AVF) and grafts (AVG) for hemodialysis access generally provide good long-term solutions for the patient with end-stage renal disease. However, complications of both AVGs and AVFs are common and require a multimodality approach to maintain their patency and continued use. Commonly encountered problems include stenosis, thrombosis, aneurysm or pseudoaneurysm formation, rupture, and infection. Each needs to be addressed on a case-by-case basis. Outflow stenosis, often occurring within the cephalic arch in patients with a brachiocephalic fistula, may occur alone or be discovered in conjunction with other access problems. Pseudoaneurysm of the venous end generally arises from traumatic weakening of the vessel wall, often from repetitive venipuncture. More rare is the fracture of a previously placed stent. We present a case of stent fracture complicated by pseudoaneurysm formation with concomitant stenosis of the cephalic arch treated successfully with single-procedure placement of endovascular stent grafts.
authors: Department of Radiology, Baylor University Medical Center at Dallas (Kershen), and Radiology and Nuclear Medicine, Topeka, Kansas (Marichal).
authors: L Michael
authors: LM
authors: Kershen
authors: Daniel A
authors: DA
authors: Marichal
references: Cardiovasc Intervent Radiol. 2013 Feb;36(1):133-9
references: 22735891
references: Clin Nephrol. 2012 May;77(5):409-12
references: 22551887
references: Rev Port Cardiol. 2011 Feb;30(2):213-21
references: 21553613
references: J Vasc Surg. 2011 Oct;54(4):1088-94
references: 21658886
references: Semin Vasc Surg. 2011 Jun;24(2):119-27
references: 21889101
references: Am J Kidney Dis. 2001 Jan;37(1 Suppl 1):S137-81
references: 11229969
references: J Endovasc Ther. 2011 Oct;18(5):613-23
references: 21992630
references: N Engl J Med. 2010 Feb 11;362(6):494-503
references: 20147715
references: Semin Dial. 2008 Nov-Dec;21(6):553-6
references: 18764789
references: Vasc Endovascular Surg. 2011 Oct;45(7):654-9
references: 21984031
references: J Vasc Interv Radiol. 2012 Apr;23(4):479-87
references: 22464712