Arterial compression by an adjacent venous stent graft in a patient undergoing dialysis

Stent graft is effective for management of balloon-angioplasty-related complications in hemodialysis access. These complications include post-angioplasty venous rupture, dissection/recoil, and acute formation of pseudoaneurysm.

We report a stent-graft complication that caused immediate acute arterial insufficiency by external compression. An 84-year-old woman presented with acute arteriovenous graft thrombosis. During percutaneous balloon thrombectomy, a stent graft was placed because of persistent recoil and mural thrombus, but the flow into the arteriovenous graft immediately ceased. External compression of the brachial artery was observed. A nitinol self-expandable stent was deployed in the brachial artery to oppose the external compression. The flow in the arteriovenous graft was recovered.

This case demonstrates the possibility of arterial compression by an adjacent venous stent graft, especially in a patient with a thin habitus and a brachial-brachial arteriovenous graft. Detailed identification of the outflow vein anatomy before stent implantation is mandatory to avoid such a complication.