Retrograde dissection of the axillary artery during arteriogram via arteriovenous access

Retrograde arterial dissection is a recognized complication of endovascular intervention but has not been well reported especially in the context of dialysis arteriovenous access procedures. The management of this complication is also not well defined.

We report the case of an 80-year-old female with end-stage renal disease (ESRD) on dialysis who developed an asymptomatic retrograde dissection of the left axillary artery during an arteriogram performed via a retrograde approach as part of access dysfunction evaluation. The condition was managed conservatively with no other intervention and close follow-up. No surgical intervention or stenting was needed in this case.

Conservative management of retrograde arterial dissection in the arm may be a viable option especially in asymptomatic patients due to the nature of the injury. The force of blood flow in the antegrade direction limits the expansion of the false lumen and likely promotes the spontaneous healing of the vessel.