Massaging thrombosed PTFE hemodialysis access graft - recipe for disaster.

Early thrombosis of a polytetrafluoroethylene (PTFE) graft used for hemodialysis vascular access can result from technical error or hypotension and hypovolaemia in the immediate postoperative period. Massaging a graft to dislodge a freshly formed thrombus with a view to restoring blood flow can lead to acute limb ischaemia from embolisation of the artery as a result of migration of the thrombus from the arterial end of the graft, hence massaging of thrombosed grafts should be avoided. This report describes the management of a 35-year-old diabetic male who developed acute ischaemia of hand due to embolisation of the radial artery following massage of a thrombosed brachio-basilic forearm PTFE loop graft.