SINGLE LIMB PATENCY OF POLYTETRAFLUOROETHYLENE DIALYSIS LOOP GRAFTS MAINTAINED BY TRAUMATIC FISTULIZATION

The purpose of this report is to describe an unusual presentation of o bstructive neointimal hyperplastic lesions in loop prosthetic dialysis grafts. The case histories and imaging studies of two patients with p artial graft thrombosis are presented. The literature of unexpected fi stulae from prosthetic dialysis grafts to adjacent veins is reviewed. Signs and symptoms that would lead a clinician to suspect the diagnosi s are emphasized. There were two dialysis grafts with partial thrombos is and arterial limb patency maintained by iatrogenic fistula. These f istulae occurred from the erosion of pseudoaneurysms in one case and a n apparent needle stick without pseudoaneurysm in the other. Both graf ts had high-grade stenotic lesions affecting the venous outflow. In th e first case this was not recognized until the graft reclotted 2 days after thrombectomy. In the most extreme cases of graft/vein fistulae, i.e., partial graft thrombosis with arterial limb patency maintained b y the fistula there is always associated venous anastomotic or outflow stenoses which must be addressed.