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

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, Texas

Suman Annambhotla, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, Texas

Carlos Bechara, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, Texas

Panagiotis Kougias, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, Texas

Tam T. Huynh, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, Texas

Alan Dardik, MD

Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, and VA Connecticut Healthcare System, New Haven, Connecticut

Michael B. Silva, Jr, MD

Section of Vascular Surgery, Department of Surgery, The University of Texas Medical Branch, Galveston, Texas

Peter H. Lin, MD

Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, Texas, plin{at}bcm.tmc.edu

Introduction Hemodialysis access—related pseudoaneurysm 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 pseudoaneurysm 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 pseudoaneurysms using endografts is a safe and effective treatment strategy in patients with hemodialysis-related pseudoaneurysm.

Key Words: arteriovenous grafts • endograft exclusion • endovascular repair • hemodialysis • hemodialysis complication pseudoaneurysm • stent graft repair

This version was published on June 1, 2008

Vascular and Endovascular Surgery, Vol. 42, No. 3, 228-234 (2008)
DOI: 10.1177/1538574408314443


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