Dissektion einer Shuntprothese – Eine Blickdiagnose im Duplex

Abstract

The diagnostic procedure and treatment strategy for The following case report describes the diagnostic procedure and the treatment strategy based on it for an acute loop shunt closure on the thigh, based on astemming from dissection of the an early shunt puncturable prosthesis, in a complex case is described in a complex case. with a loop shunt on the thigh made of prosthesis material that can be punctured. This rare cause of occlusion could bewas preoperatively identified preoperatively by a precise duplex sonographic examination. Based on this result, an optimal therapeutic approach could bewas planned and implemented. Due to a lack of suitable vein materialIn a 38-year-old dialysis patient, an arteriovenous prosthetic loop shunt (GORE® ACUSEAL Vascular Graft, 6 mm, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) was implanted on in the right thigh of a 38-year-old dialysis patient with a prosthesis (GORE® ACUSEAL Vascular Graft, 6 mm, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) due to a lack of suitable veins. Because of a shunt closure due to material fatigue, the prostheses prosthesis had to berequired partially replacedreplacement after only 20 months. Six weeks postoperatively The the patient presented again 6 weeks postoperatively with a new shunt closure. Using duplex sonography A a 4 cm long longitudinal dissection of the prosthesis was detected in the arterial part section of the new portion of the prosthesis portion using duplex sonography. This was confirmed intraoperatively. The remaining parts of the prosthesis were normal and intact. Dialysis had to be performed preoperatively, so that the patient received a left inguinal Shaldon catheter the day before the operationrevision of the loop shunt. At revisionFor this reason, dissection was confirmed. This part of and an early puncturable prosthesis the was resected and replaced not inserted as replacement. Instead theimplantation of early puncturable prostheses was dispensed with intraoperatively. A new prosthesis segment was inserted replaced (with a not early puncturable prosthesis (BARD VENAFLO® ll Vascular Graft, Straight, 6 mm, Bard Peripheral Vascular Inc., Tempe, USA)). The postoperative course was straightforward and discharge the patient was discharged on timetimely. This was confirmed intraoperatively. Dissection of an early-puncturable cannulation trilayered Shunt shunt prosthesesprosthesis , which allow early cannulation, is a rare complication and has not of such trilayered prostheses. such a problem has notpreviously been described in the literature. In the case ofShould occlusion occur in an early-cannulablecannulation trilayered shunt prosthesis occlusion and the presence of early cannulable trilayered prostheses a,dissection must be excluded. For this Reason, dDuplex sonography is the an appropriateexaminationdiagnostic procedure.