Management of arteriovenous graft stenosis part 1

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

 

A diameter reduction of >50% of the lumen together with a significant flow decline is considered as an indication for treatment.

Stenosis at the arterial anastomosis

As in autogenous fistula, most arterial inflow stenosis in grafts can succesfully be treated by percutaneous transluminal angioplasty. Stenosis of the arterial anastomosis itself can be dilated, if only the afferent artery and the graft at the anastomosis are affected and there is no stenosis in the efferent artery. If there is an additional stenosis of the efferent artery, angioplasty of the anastomosis alone will enhance graft flow with the risk of peripheral ischemia due to reduced peripheral arterial perfusion. In these patients, either dilatation of the efferent artery by interventional radiology through surgical revision of the anastomosis may resolve the dilemma.

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