Single limb patency of polytetrafluoroethylene dialysis loop grafts maintained by traumatic fistulization

The purpose of this report is to describe an unusual presentation of obstructive neointimal hyperplastic lesions in loop prosthetic dialysis grafts. The case histories and imaging studies of two patients with partial graft thrombosis are presented. The literature of unexpected fistulae from prosthetic dialysis grafts to adjacent veins is reviewed. Signs and symptoms that would lead a clinician to suspect the diagnosis are emphasized. There were two dialysis grafts with partial thrombosis and arterial limb patency maintained by iatrogenic fistula. These fistulae occurred from the erosion of pseudoaneurysms in one case and an apparent needle stick without pseudoaneurysm in the other. Both grafts had high-grade stenotic lesions affecting the venous outflow. In the first case this was not recognized until the graft reclotted 2 days after thrombectomy. In the most extreme cases of graft/vein fistulae, i.e., partial graft thrombosis with arterial limb patency maintained by the fistula there is always associated venous anastomotic or outflow stenoses which must be addressed.