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Srpski arhiv za celokupno lekarstvo 2010 Volume 138, Issue 3-4, Pages: 233-235
https://doi.org/10.2298/SARH1004233R
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Resection of thrombosed femoral artery over-dimensional stent-graft placed due to multiple arteriovenous fistulas following gunshot wounds

Radak Đorđe (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Tanasković Slobodan ORCID iD icon (Institut za kardiovaskularne bolesti "Dedinje", Beograd)
Nenezić Dragoslav (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Vučurević Goran (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Popov Petar (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Gajin Predrag (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Babić Srđan (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Aleksić Nikola (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Miličić Miroslav (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Matić Predrag (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Ilijevski Nenad (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)

Introduction. Though surgical approach is common in arteriovenous (AV) fistula treatment, endovascular procedures such as stent-graft placement has become more popular in recent years. We aim to present a case of thrombosed femoral artery stent-graft which was placed one year earlier due to multiple AV fistulas following gunshot wounds. Case Outline. A 43-year-old patient was admitted to the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, Serbia, for arteriography. Five years before, he had suffered from six gunshot wounds in his right leg and one year before, in the health centre in Vienna, stent-graft had been placed in the right superficial femoral artery due to multiple AV fistulas. Because of artery dilation proximal to AV fistula location, a large dimensional stent-graft had to be placed (24 mm). After admission, arteriography and Multislice CT (MSCT) angiography revealed thrombotic masses in the stent-graft with intraluminal stenosis of 50%. Extirpation of thrombosed stent-graft was performed followed by Dacron tubular graft 10 mm interposition. On the fifth postoperative day, the patient was discharged from the clinic, and after 3 months, the right leg vascularisation was well preserved. Conclusion. Large dimensional stent-graft placement in patients with mutiple AV fistulas and blood vessel dilation proximal to AV site of communication carries an increased risk of thrombotic events due to turbulent blood flow and parietal thrombosis occurrence. Though stent-graft placement can be a very useful solution in acute AV fistula treatment, the very same thrombosis should be thought of when surgical management is the only treatment choice.

Keywords: stent-graft thrombosis, superficial femoral artery, Dacron graft

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