Complications of endovascular grafts in the treatment of pseudoaneurysms and stenoses in arteriovenous access

Abstract

Significant life-threatening complication can arise when fracture and migration of the stent grafts used for treating AV access occur. Herald bleed with a previously placed stent graft may be a harbinger of future rupture. Complications appear less likely when stent grafts are used to treat stenosis; however, when complications occur, access site salvage is rare. Surgical revision in the case of pseudoaneurysm should be considered for access preservation.

Arteriovenous shunt graft ulceration with sinus and graft epithelialization

“…Migration of the stent occurs due to continuous growth and increasingly tortuous anatomy of pseudoaneurysms, improper fixation, early puncture, chronic inflammation and low-grade infection. Lastly, stent fracture, skin erosion and infection can occur as multiple punctures from each dialysis session increase the risk of these complications [4]. When stent fracture has occurred, the stent may protrude through the skin, and lead to chronic infection [2].…”

“…Silas et al, found one case of infected skin ulcer, which developed one month after the placement of a Wallgraft® stent graft [7], and Asif et al, reported a case where the stent graft was found protruding through the skin and three cases of sepsis and cellulitis of skin overlying the stent graft [5]. In addition, other studies have reported cases of soft tissue infection associated with exposed stent graft or stent fracture [3,4]. Unlike these studies, we did not find an exposed stent or stent fracture, in fact our specimen did not include the stented segment.…”

Management of Aneurysm, Pseudoaneurysm and Infective Complications of Hemodialysis Access

“…Other complications reported with covered stents include infection, migration, stent rupture, erosion, and bleeding. 7,9,11 The presentations could be access thrombosis, recurrence of pseudoaneurysm or bleeding. The risk of infective complication of covered stent was noted to be higher when skin erosion is present over the pseudoaneurysm.…”

Salvage of autogenous dialysis access with balloon-assisted thrombin injection

“…However, this approach may introduce other complications, including bleeding secondary to requisite use of antiplatelet agents, persistent infections, and stent migration or fracture. [1][2][3] An alternative to endovascular stent graft placement for PSA management is ultrasoundguided thrombin injection (UGTI). While successful use of UGTI to treat PSAs has largely been discussed in the context of femoral pseudoaneurysms, [4][5][6] several reports have also demonstrated its utility in autogenous dialysis access PSAs.…”