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First published on March 28, 2008, doi:10.1177/1538574408314443

Vascular and Endovascular Surgery 2008;42:228.

A more recent version of this article appeared on June 1, 2008

Article

Endovascular Repair of Hemodialysis Graft-Related Pseudoaneurysm: An Alternative Treatment Strategy in Salvaging Failing Dialysis Access

Neal Barshes, Suman Annambhotla, Carlos Bechara, Panagiotis Kougias, Tam Huynh, Alan Dardik, Michael B. Silva Jr, and Peter H. Lin*

* To whom correspondence should be addressed. E-mail: plin{at}bcm.edu.


  Abstract

Introduction. Hemodialysis access–related pseudo-aneurysm is a known complication in patients requiring hemodialysis via prosthetic arteriovenous grafts (AVGs). The traditional treatment strategy of AVG-related pseudoaneurysms is either AVG ligation or interposition replacement with another prosthetic graft segment or autogenous veins.

Patients and methods. From June 2002 to August 2007, 32 self-expanding stent grafts were implanted in 26 patients with AVG pseudoaneurysms. Indications for treatment consisted of large AVG pseudoaneurysm size, localized pain at pseudoaneurysm site, enlarging pseudoaneurysm, and skin site breakdown. AVG pseudo-aneurysm exclusion was accomplished with Wallgrafts, Viabahn endoprosthesis, and Fluency endograft. Technical success was achieved in all patients. Nineteen patients experienced a marked decrease in the size of their pseudoaneurysm following endograft exclusion. Successful hemodialysis was resumed through endograft-excluded AVG in all patients within 48 hours.

Conclusions. Endoluminal exclusion of AVG pseudo-aneurysms using endografts is a safe and effective treatment strategy in patients with hemodialysis-related pseudoaneurysm.


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