Abstract
BackgroundStent placement in the cephalic arch is being used with increasing frequency. Late complications of bare metal and stent grafts in dialysis access, in particular stent migration, are often under-reported and can lead to compromise of future dialysis circuits.Case presentationA 52-year-old man developed acute arm swelling 2 days after creation of a left arm brachio-basilic arteriovenous graft. The axillary vein was found to be jailed by a previously deployed cephalic arch stent graft which had migrated into the subclavian vein. There was failure to cross through the fabric of the stent graft using conventional chronic total occlusion wires and techniques. A TruePath device was used successfully to cross through the fabric of migrated cephalic arch stent graft and recanalise the short subclavian-axillary vein occlusion.ConclusionThe adapted use of a drilling chronic total occlusion device to drill through the fabric of migrated stent graft was performed successfully to allow complete recanalisation of the occluded axillary vein.
Highlights
The adapted use of a drilling chronic total occlusion device to drill through the fabric of migrated stent graft was performed successfully to allow complete recanalisation of the occluded axillary vein
Stent-graft (SG) placement for cephalic arch stenosis in dysfunctional dialysis access is an option for patients, and a recent systematic review suggests that it may be more durable in the short term compared to angioplasty alone (Miller et al 2018; D’Cruz et al 2019)
We report the novel use of a diamond tipped chronic total occlusion (CTO) drilling device, TruePath (Boston Scientific, MA, USA), to
Summary
Stent-graft (SG) placement for cephalic arch stenosis in dysfunctional dialysis access is an option for patients, and a recent systematic review suggests that it may be more durable in the short term compared to angioplasty alone (Miller et al 2018; D’Cruz et al 2019). On a subsequent venoplasty procedure 5 months later, the central end of the stent had migrated into the subclavian vein resulting in jailing of the axillary vein with consequent occlusion of that segment (Fig. 1). Attempts to cross the axillary vein occlusion using 0.035′′ standard guide wires, 0.018′′ glide wires (Terumo, Tokyo, Japan), a 0.014′′ Winn 200 T (Abbott Vascular, CA, USA) and 0.018′′ Victory 25 g (Boston Scientific, MA, USA) CTO wires were all unsuccessful due to the inability to traverse the fabric of the Fluency SG (Fig. 2). Via the AVG 4F sheath, using co-axial support of a 4F Berenstein catheter (Cordis, CA, USA) and a 0.018′′ CXI support microcatheter (Cook Medical, IN, USA), the TruePath CTO drilling device was advanced along the basilic and axillary vein up to the point of occlusion. A Supera stent was chosen for its crush-resistance properties, superior flexibility and kink resistance
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