A Case Report of Combined Endovascular Bypass with Endovascular Fistula Repair in a Previously Perforated Artificial Vessel

Abstract

This case utilizes the characteristics of both penetrating prostheses to skillfully repair and bypass a dialysis endovascular stenosis and a tumor-like dilatation with thrombus, not only sparing the patient the transition period of long-term tube placement, but also providing a new surgical mindset for similar situations.

The patient's vascular resources were depleted after multiple endovascular fistula reconstructions in the left upper extremity, and vascular ultrasound of the right upper extremity suggested the formation of a large appendage thrombus in the lumen of this site, resulting in a significantly smaller effective vessel lumen; The downstream vein was markedly tortuous; consecutive bilateral stenosis was seen near the elbow, with a stenosis rate of 78%, and the elbow was succeeded by a noble vein of the upper arm with a diameter of about 6 mm. suggestive of an artificial arteriovenous fistula luminal verrucous dilatation with infection. The patient expressed a desire to avoid prolonged tube confinement during the transition to dialysis. Additionally, the patient requested excision of the infected endocardial fistula vascular segment and concurrent repair of the dilated segment of the endocardial fistula, which constituted the articulation of both penetrating artificial blood vessels. The patient was successfully dialyzed via artificial vascular puncture at the three-day postoperative mark. The appropriate cutting and repair of the articulation, coupled with the utilisation of the distinctive attributes of both-penetrated artificial blood vessels, can facilitate the expeditious transition of the patient into a routine dialysis regimen. This approach preserves the patient's vascular resources and circumvents the risk of infection.