Iatrogenic Arteriovenous Fistula as a Complication of a Polytetrafluoroethylene (PTFE) Graft for Hemodialysis

Abstract

The authors describe 2 patients who developed an iatrogenic arteriovenous fistula between a straight forearm polytetrafluoroethylene (PTFE) graft and an in situ cephalic vein after posterior puncture of the graft with a hemodialysis cannula. Diagnosis of this iatrogenic fistula was by careful inspection of the PTFE graft. The distal PTFE graft was functional, but the proximal graft was thrombosed at the ill-placed puncture site. Superficial veins on the anterior forearm exhibited a thrill and bruit. Treatment was simple ligation of the fistula and revascularization of the thrombosed segment of the PTFE graft. When the fistula occurred with a pseudoaneurysm, treatment was ligation of the fistula, exclusion of the pseudoaneurysm, and interposition graft to maintain vascular continuity. This complication of vascular access is not documented in the literature.

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References

Halstuck K. , Berns A. : Aneurysmal disease and puncture site complications in vascular access. In: Vascular Access for Hemodialysis II, ed. by Sommer BG , Henry ML. W.L. Gore and Associates, Inc. , and Precept Press, Inc. , 1991, pp. 75-84.