Stent grafts have improved secondary patency in arteriovenous grafts (AVGs) by effectively treating venous outflow lesions and have contributed to prolonged secondary patency of AVGs. As AVGs remain functional for longer periods, degeneration of the prosthetic graft itself becomes more frequent, increasing the need for graft-side interventions. During surgical reconstruction of AVGs, surgeons may be required to manage previously implanted stent grafts. We report a case of AVG reconstruction using the transected end of a pre-existing stent graft as the venous anastomosis. A 78-year-old woman undergoing long-term hemodialysis developed graft degeneration with recurrent stenosis despite a functioning stent graft in the venous outflow. Because creation of a new vascular access on the other arm was not feasible, ipsilateral reconstruction was performed. A new prosthetic graft was anastomosed to the radial artery arising from a high bifurcation of the brachial artery at the distal upper arm, near the elbow. On the venous side, the prosthetic graft overlapping the stent graft was completely excised, and the stent graft was transected at a segment not overlapped by the prosthetic graft within the native vein. End-to-end anastomosis was then created between the new prosthetic graft and the transected stent graft. Postoperative angiography confirmed good patency of the anastomosis and venous outflow, and access flow improved significantly. The reconstructed AVG was suitable for cannulation 10 days after surgery. This case suggests that reuse of a transected stent graft during AVG reconstruction may be technically feasible in carefully selected patients.
Nojima et al. (Mon,) studied this question.