Zhang Xi, Hu Bo, Xu Yong, Lai Qiquan, Chen Ling, Gao Xuejing, Tu Bo, Chen Bo, Zhou Yu, Wan Ziming
Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
J Vasc Access. 2023 Nov;24(6):1507-1512. doi: 10.1177/11297298221074455. Epub 2022 Feb 14.
Arteriovenous (AV) grafts are an alternative vascular access for chronic hemodialysis. AV graft failure is often due to stenosis of the feeding artery, graft, or draining vein. We report four cases of AV graft dysfunction and failure rarely caused by graft delamination and dissection. Two males and two females aged 47-67 years had been on chronic hemodialysis. Ultrasound examination detected graft delamination and dissection between 1 and 33 months after Acuseal AV graft implantation. Two cases were successfully treated with stenting and partial graft replacement, respectively. False lumen volume reduction by fluid withdrawal failed to salvage the delaminated graft in one of the patients. The delamination and dissection of another case spontaneously resolved 5 months later. Graft delamination and dissection should be considered as a possible cause for AV graft dysfunction and failure. Stenting and graft replacement may be recommended to treat AV graft dissection and delamination.
动静脉（AV）移植物是慢性血液透析的一种替代性血管通路。AV移植物失败通常是由于供血动脉、移植物或引流静脉的狭窄。我们报告了4例罕见的因移植物分层和夹层导致的AV移植物功能障碍和失败病例。4名年龄在47 - 67岁的患者（2男2女）接受慢性血液透析。超声检查在Acuseal AV移植物植入后1至33个月检测到移植物分层和夹层。其中2例分别成功接受了支架置入和部分移植物置换治疗。1例患者通过抽液减少假腔容积未能挽救分层的移植物。另一例的分层和夹层在5个月后自行缓解。移植物分层和夹层应被视为AV移植物功能障碍和失败的可能原因。对于AV移植物夹层和分层，可能建议采用支架置入和移植物置换治疗。
