Cannulating the hemodialysis access through a stent graft - is it advisable?

Pseudoaneurysms frequently develop at cannulation sites in arteriovenous grafts. The current treatment options are either open surgical revision or endovascular placement of stents to cover the pseudoaneurysm. The ideal treatment option needs to be individualized based on the clinical assessment and the involved risks with the procedure. The safety of cannulating the dialysis access through a stent graft for hemodialysis has not been conclusively established and needs to be avoided when possible. This case report emphasizes the hazards associated with cannulation of stent grafts, including stent fracture and leakage of blood into the surrounding tissue with recurrence of pseudoaneurysm.