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Findings: Thrombosis throughout much of the venous limb of the graft, most prominent near the venous anastomosis.

Large pseudoaneurysm with extravasation of contrast from the graft.

Diagnosis: Dialysis graft thrombosis and pseudoaneurysm.

Discussion: Angiography is indicated to assess dialysis grafts if there is diminished blood return or difficulty cannulating during dialysis, decreased graft pulsation or a mass, evidence of venous stasis or digital ischemia.

The fistula can be assessed either by brachial artery puncture or direct graft puncture. Angiographic abnormalities include:

1. Thrombosis - most common cause of graft failure. Usually near venous anastomosis.
2. Stenosis - pseudointimal hypoplasia secondary to high turbulent flow.
3. Aneurysms and pseudoaneurysms.

Balloon dilatation, stent placement, and thrombolytic agents are all radiologic techniques used to restore blood flow. Unfortunately in this patient, the pseudoaneurysm required surgical repair.

References:
Kadir, Saadoon, M.D. Diagnostic Angiography. W. B. Saunders Co., Philadelphia. 1986.

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