Abstract
BackgroundGraft thrombosis due to fabric delamination is a rare cause of delayed failure of arteriovenous grafts. Graft delamination is primarily an imaging diagnosis and is confirmed with the help of ultrasound which shows the separation of graft fabric layers. Only two such cases have been described in the literature so far.Case presentationWe present a case of upper extremity arteriovenous graft thrombosis in a 79 year old COVID-19 positive patient with end-stage renal disease. The diagnosis was established on ultrasonography which revealed separation of the graft fabric layers with thrombosis within the “false” and “true” lumen of the graft. The patient was managed with angioplasty and embolectomy of the clot material followed by stent-graft placement across the delaminated portion of the graft. Post-procedural angiography confirmed brisk flow across the graft and patient could successfully have subsequent hemodialysis sessions.ConclusionsIdentification of graft delamination as a cause of graft failure is important as its management differs from other conventional causes since it requires stent-grafts to cover the area of delamination to re-establish flow and salvage the AV graft. The recognition of this phenomenon is essential to provide quality care and successful reuse of the AV graft.Level of evidenceLevel 4, Case Report.
Highlights
Graft thrombosis due to fabric delamination is a rare cause of delayed failure of arteriovenous grafts
We describe a case of graft thrombosis due to the rare phenomenon of fabric delamination and its management
Case presentation A 79-year-old woman with End-stage renal disease (ESRD) and a positive COVID-19 test on maintenance hemodialysis presented to the emergency department after multiple failed attempts to cannulate her left upper extremity AV graft
Summary
Numerous reports of graft delamination have been published in the US Food and Drug Administration’s. There was a persistent defect in the midportion of the graft appearing distinct from the typical intra-graft concentric stenosis and intraluminal thrombus This occurred due to the delamination of the graft which created a false lumen that was compressing the true lumen. Management of graft delamination differs from that of conventional stenosis as delamination cannot be corrected by conventional angioplasty and thrombectomy, which are typically used to salvage the AV grafts In these patients, stent-grafts are needed to cover the area of delamination to open the true lumen and prevent the flow of blood into the false lumen. Stent-grafts are needed to cover the area of delamination to open the true lumen and prevent the flow of blood into the false lumen This can be confirmed by improved flow visualization, physical examination and angiographic appearance.
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