TITLE:  Case report of an arteriovenous graft for renal dialysis, with multiple complications treated successfully over 5 years.

INTRODUCTION: Arteriovenous grafts (AVG) is a good alternative when native arteriovenous fistula (AVF) is not possible. However, complications are higher and close surveillance is required for successful salvage intervention.

PRESENTATION OF CASE: We present the case of a 35 year old man with a history of a successful Brachio-Axillary AVG performed in his right arm in 2012. He had a background of multiple previous failed attempts of a native AVF formation. He presented in 2014 with symptoms consistent with AVF stenosis. He underwent a successful fistuloplasty and 2 stent insertion. In June 2015 he presented again with re-stenosis and successful fistuloplasty was performed with balloon dilatation. In October 2015 he presented with AVF thrombosis. This was treated with fistuloplasty and thrombolysis. He presented again in August 2016 with a recurrent thrombosis in his AVG and this was again treated with a successful fistuloplasty and thrombolysis on two separate occasions. He then presented in September 2016 with re-stenosis. This was treated with fistuloplasty and 2 stent insertion. He underwent a successful renal transplant during this time and presented again with a sinus discharge in February 2019 when the plan was made for subtotal graft excision.

CONCLUSION: Incidence of complications is higher when a graft is used over a native AVF. However, close surveillance and prompt intervention can lead to multiple successful salvage procedures thus prolonging the lifespan of the graft. As in our case we were able to prolong the lifespan of the AVG with multiple successful interventions.

SOURCE: Mansoor T, Healy D, Moneley D. Case report of an arteriovenous graft for renal dialysis, with multiple complications treated successfully over 5 years[J]. Int J Surg Case Rep, 2020,66:158-161. DOI: 10.1016/j.ijscr.2019.11.059.

简介：当不能使用自体动静脉内瘘（AVF）时，动静脉移植物（AVG）是一个很好的选择。然而，并发症的发生率更高，成功进行抢救干预需要密切监测。

案例：我们介绍了一个35岁的男人的案例，他在2012年右臂成功进行了肱动脉-腋静脉AVG的病史。他曾有多次尝试过自体AVF建立失败的背景。在2014年出现了与AVF狭窄相符的症状。他成功进行了瘘管修补术并插入了2个支架。 2015年6月，他再次出现了再狭窄，并通过球囊扩张术成功进行了瘘管修补术。 2015年10月，他出现了AVF血栓形成。进行了瘘管修补术和溶栓治疗。他于2016年8月AVG再次出现血栓形成，并再次成功进行了瘘管修补术和溶栓治疗两次。然后，他在2016年9月出现了再狭窄，这次又进行了瘘管修补术和2个支架插入。在此期间，他接受了一次成功的肾移植手术，并在2019年2月出现了窦道分泌物并行部分移植物切除。

结论：当在自体AVF上使用移植物时，发生并发症的几率更高。但是，密切监视和及时干预可以进行多次成功的挽救程序，从而延长移植物的寿命。在我们的案例中，通过多次成功的干预，我们能够延长AVG的使用寿命。

启发：血管维护技术逐步发展，能解决的问题越来越多，也能让内瘘使用寿命明显延长。但血管维护背后的代价，反复的手术是否会给患者带来身体、心理以及经济等方面的压力，是否有舒适度更高、性价比更高的方案来解决这些棘手问题，以及每次维护后预期效果，这些都是我们通路人必须反复思考的。