Figure 515

Intragraft stenosis. A, This arteriogram demonstrates a forearm loop polytetrafluoroethylene (PTFE) graft with an intragraft stenosis (arrow). Stenotic lesions in this site are less common than those involving either the venous anastomosis or the outflow vein. B, These lesions can be treated successfully with percutaneous trans-luminal angioplasty (arrow). In cases where angioplasty is unsuccessful, intragraft stenoses can also be treated using percutaneous atherectomy or surgical revision. Since this region of the access is subject to needle cannulation, the placement of a stent would be inadvisable. Intragraft stenoses may be located between the sites of the arterial and venous needle placements during dialysis. If so, the most common screening studies, namely venous pressure measurements and recirculation, do not have abnormal findings and the lesion may remain undetected until access thrombosis develops.

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