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