Treatment of pseudoaneurysm of an arteriovenous fistulae at the tight using a stent graft

A 59-year-old man began receiving maintenance hemodialysis in 1992 secondary to IgA nephropathy. The use of arteriovenous fistulaes at the bilateral upper extremities caused recurrent technical problems, and an arteriovenous fistulae at the right thigh was generated by a great saphenous vein to femoral artery anastomosis in 1993. Angioplasty was required for management of aneurysm of the arteriovenous fistulae in 1996. However, a pulsatile mass arose around the arteriovenous fistulae, and the patient presented to our institution in March 2001 with complaints of local swelling and discomfort. Angiography demonstrated entry of contrast media into a pseudoaneurysm at the proximal portion of the saphenous vein loop. On April 12, 2001, the patient successfully underwent placement of an intravascular stent graft (Passager® 6mm×10cm, BOSTON SCIENTIFIC, USA) with preservation of the internal shunt function and closure of the pseudoaneurysm. The pseudoaneurysm gradually reduced in size, leaving the arteriovenous fistulae available for hemodialysis. Maintenance hemodialysis was performed via the internal shunt until the patient's death in May 2002.