Arteriovenous Graft Delamination and Dissection as a Cause of Graft Dysfunction

Dai, Rui; Broadwell, Scott R.; Lessne, Mark L.; Kim, Charles Y.

doi:10.1016/j.jvir.2019.11.019

Cited by 4 publications

(9 citation statements)

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“…We report four cases with dissections and delamination of the Acuseal AV graft. With the previous reported cases, [3][4][5] there are 12 cases of Acuseal graft dissection and delamination. In addition, there is a case report that described a dissection of a Hybrid AV graft.…”

Section: Discussionmentioning

confidence: 81%

“…In addition, there is a case report that described a dissection of a Hybrid AV graft. 3 However, the delamination and dissection rate of the Acuseal grafts remains unknown. All four cases in the present report are related to the Acuseal graft.…”

Section: Discussionmentioning

confidence: 99%

“…A few cases of graft delamination have been reported last year. [3][4][5] However, the clinical characteristics and pathogenic mechanisms of AV graft delamination and dissection are largely unknown probably due to inadequate clinical observation and limited case reports. Moreover, the treatment of graft delamination or dissection has not been standardized.…”

Section: Introductionmentioning

confidence: 99%

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Delamination and dissection of arteriovenous grafts: A multicenter report of four cases

et al. 2022

J Vasc Access

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Arteriovenous (AV) grafts are an alternative vascular access for chronic hemodialysis. AV graft failure is often due to stenosis of the feeding artery, graft, or draining vein. We report four cases of AV graft dysfunction and failure rarely caused by graft delamination and dissection. Two males and two females aged 47–67 years had been on chronic hemodialysis. Ultrasound examination detected graft delamination and dissection between 1 and 33 months after Acuseal AV graft implantation. Two cases were successfully treated with stenting and partial graft replacement, respectively. False lumen volume reduction by fluid withdrawal failed to salvage the delaminated graft in one of the patients. The delamination and dissection of another case spontaneously resolved 5 months later. Graft delamination and dissection should be considered as a possible cause for AV graft dysfunction and failure. Stenting and graft replacement may be recommended to treat AV graft dissection and delamination.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delamination and dissection of arteriovenous grafts: A multicenter report of four cases

et al. 2022

J Vasc Access

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“…Previous reports demonstrated that delamination occurred shortly after endovascular treatments in five cases. 5,6 Balloon angioplasty might separate each layer, resulting in delamination. In case 2, we inferred that cannulation needling was a trigger.…”

Section: Discussionmentioning

confidence: 99%

Delamination of Acuseal arteriovenous graft: Two case reports

et al. 2023

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Acuseal arteriovenous graft is an early cannulation graft having a tri-layered structure with an elastomeric middle layer. However, delamination of Acuseal grafts has been reported recently. This article describes two cases with different characteristics of Acuseal delamination. In case 1, the delamination occurred 1 month after a percutaneous transluminal angioplasty (PTA); therefore, the PTA was suspected to be a trigger. The delamination was located between the outer expanded polytetrafluoroethylene (ePTFE) layer and the elastomeric middle layer. On the other hand, in case 2, the delamination was located between the luminal ePTFE layer and the elastomeric middle layer. A surveillance ultrasound examination detected the delamination unexpectedly in the uneventful course; however, the delaminating location corresponded to the cannulation puncture site and the intraoperative findings suggested the involvement of mis-needling as a possible cause. Interestingly, for the purpose of continued use on hemodialysis, specific treatments were required against the delamination itself in both cases. As we identified Acuseal delamination in 5.6% (2/36) of cases, concerns arise that numerous cases of Acuseal delamination may have been overlooked in general. Understanding and recognizing this phenomenon are important for adequate use of Acuseal graft.

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“…Numerous reports of graft delamination have been published in the US Food and Drug Administration’s Manufacturer and User Facility Device Experience Database, but only two cases have been published to date, which reports endovascular management of this complication (Dai et al 2020 ). In our case, there was no significant stenosis at the venous anastomosis, but there was presence of thrombus in the entirety of the graft, which was partially corrected with balloon angioplasty and balloon-assisted platelet plug embolectomy.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of arteriovenous graft dysfunction as a result of graft delamination and fracture

et al. 2021

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Background Graft 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 presentation We 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. Conclusions Identification 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 evidence Level 4, Case Report.

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Arteriovenous Graft Delamination and Dissection as a Cause of Graft Dysfunction

Cited by 4 publications

References 1 publication

Delamination and dissection of arteriovenous grafts: A multicenter report of four cases

Delamination and dissection of arteriovenous grafts: A multicenter report of four cases

Delamination of Acuseal arteriovenous graft: Two case reports

Endovascular treatment of arteriovenous graft dysfunction as a result of graft delamination and fracture

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