Abstract
Excision of infected synthetic haemodialysis grafts with arterial repair can be extremely challenging due to friable vessels. We present a case of an infected pseudo-aneurysm of a synthetic necklace dialysis graft, where surgical repair of the axillary artery was attempted but not technically feasible. Emergency endovascular covered stenting was performed and the patient has now been free of complications for 4 years. Placing covered stents at infected sites remains controversial but we support endovascular treatment as a viable alternative in the emergency management of infected pseudo-aneurysms related to synthetic grafts and report long term good results in this case.
Highlights
Synthetic grafts are placed for haemodialysis access in patients when other access options have been exhausted [1]
We report a case of a beta-haemolytic streptococcus group B infected pseudoaneurysm of an axillary arteriovenous dialysis necklace graft, managed by emergency endovascular covered stenting of the artery where surgery became complicated peri-operatively
At operation the remnant stump of the necklace graft had detached from the native axillary artery and a pseudo-aneurysm was present
Summary
Synthetic grafts are placed for haemodialysis access in patients when other access options have been exhausted [1]. These synthetic grafts may act as a nidus for infection and ideal management is by excision and vessel repair [2]. We report a case of a beta-haemolytic streptococcus group B infected pseudoaneurysm of an axillary arteriovenous dialysis necklace graft, managed by emergency endovascular covered stenting of the artery where surgery became complicated peri-operatively.
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