You Can Do That? Performing Total Recanalization of Completely Stented Arterial-venous Grafts

Establishing venous access in chronic dialysis patients is conducted by the insertion of polytetrafluoroethylene arterial-venous (AV) grafts. The continual access of these grafts allows for potential failure over extended periods of hemodialysis treatment, as a result of thrombosis and pseudoaneurysm formation. Patency of AV grafts requires interventional management of thrombosis and pseudoaneurysm formation, including thrombectomy and covered stent placement, respectively. In 2013, the Food and Drug Administration approved the Gore REVISE study, giving indication for covered stents within AV grafts. If covered stent placement is required to treat a thrombosed AV graft, it is still possible to perform a percutaneous thrombectomy procedure afterwards. Direct access of the AV graft by passing through both the graft material and covered stents allows for interventional radiology management to be performed without compromise of the stent or graft. This interventional method of direct access can salvage the AV graft before considering further invasive management, such as a new surgical venous access site.