Delamination and dissection of arteriovenous grafts: A multicenter report of four cases

Area of Science:

• Vascular Surgery
• Nephrology
• Medical Imaging

Background:

• Arteriovenous (AV) grafts are essential for chronic hemodialysis access.
• Common causes of AV graft failure include stenosis in the artery, graft, or draining vein.
• Rare complications like graft delamination and dissection can also lead to AV graft dysfunction.

Observation:

• Four cases of AV graft dysfunction and failure due to graft delamination and dissection are presented.
• Ultrasound identified delamination and dissection in Acuseal AV grafts between 1 and 33 months post-implantation.
• Patient demographics included two males and two females aged 47-67 years undergoing chronic hemodialysis.

Findings:

• Two patients were successfully treated with stenting and partial graft replacement.
• Fluid withdrawal to reduce false lumen volume was ineffective in one case.
• One instance of delamination and dissection resolved spontaneously after five months.

Implications:

• Graft delamination and dissection should be recognized as a potential cause of AV graft failure.
• Interventional strategies such as stenting and graft replacement may be effective treatments.
• Further research into the mechanisms and optimal management of graft delamination is warranted.