Vascular access graft thrombosis by iatrogenic fistula

Abstract

AbstractProsthetic arteriovenous graft thrombosis is multifactorial and includes stenosis of the graft‐venous and graft‐arterial anastomosis, excessive compression for hemostasis at the end of dialysis, complication of dialysis needle placement, hypotension, hypovolemia, and hypercoagulable states. We report a case of arteriovenous graft thrombosis resulting from a traumatic fistula between an arteriovenous graft and the adjacent basilic vein related to repeated cannulation. A 49‐year‐old female with end‐stage renal disease visited our department with a thrombosed left forearm arteriovenous graft. On physical examination, there was strong pulsation on the arterial limb of the graft, but no thrill and bruit on the venous limb. Fistulography was performed for endovascular treatment of the arteriovenous graft thrombosis. However, it showed a fistula arising from the dialysis graft and communicating with the adjacent basilic vein. The purpose of this discussion is to highlight a rare cause of vascular access graft thrombosis including etiology, pathophysiology, diagnosis, prevention, and treatment.