Ry. Kanterman et Tm. Vesely, GRAFT-TO-VEIN FISTULAS ASSOCIATED WITH POLYTETRAFLUOROETHYLENE DIALYSIS GRAFTS - DIAGNOSIS AND CLINICAL-SIGNIFICANCE, Journal of vascular and interventional radiology, 6(2), 1995, pp. 267-271
PURPOSE: To describe the diagnosis and morphology of abnormal fistulas
between dialysis grafts and adjacent native veins in five patients an
d to discuss their clinical significance. PATIENTS AND METHODS: Five p
atients with PTFE loop-type forearm dialysis grafts were found to have
graft-to-vein fistulas in the presence of venous outflow stenosis or
occlusion, Three patients underwent surgical revision and two patients
underwent percutaneous angioplasty of the venous obstruction, Only on
e patient required ligation of the abnormal graft-to-vein fistula, The
clinical history, dialysis records, surgical reports, and subsequent
radiographs of the fistula were reviewed to determine the clinical sig
nificance of these fistulas.RESULTS: Two patients presented with parti
al graft thrombosis; the proximal portion of the graft remained patent
due to persistent flow through the fistulous communication to an adja
cent native vein, Two other patients had a graft-to-vein fistula arisi
ng from a pseudoaneurysm, which itself was originating from the graft,
After either surgical or percutaneous treatment of the venous obstruc
tion, all five grafts remained functional during the follow-up period.
CONCLUSION: These iatrogenic, small-caliber fistulas are not uncommon
but only manifest during periods of elevated graft pressure, Once the
graft pressure is normalized, these fistulas have minimal hemodynamic
effect and need not be specifically treated.