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Hephzibah, GA
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History: Clotted left upper thigh AV graft

1. Rheolytic thrombectomy of left thigh AV graft
2. The balloon angioplasty of venous outflow and venous anastomosis
3. Removal of the arterial plug with a Fogarty balloon
4. Balloon angioplasty of arterial anastomosis

Technique:Following informed consent, the patient was prepped and draped in the usual sterile fashion. The venous portion of the left upper thigh AV graft was accessed with a micropuncture needle. A 6 French vascular sheath was then placed in the graft. Rheloytic thrombectomy using the AngioJet with 10 mg TPA was performed through the venous outflow. Followup venogram demonstrated resolution of clot within the venous portion of the graft. The venous outflow was then angioplastied in multiple segments with 8mm balloon as well as the venous anastomosis. At this time, the graft was accessed in a retrograde fashion toward the arterial anastomosis and a second sheath was sequentially placed. A Fogarty balloon was then used to remove the arterial plug from the arterial anastomosis. Residual stenosis within the arterial limb was dilated with a 6 mm balloon. Completion angiogram demonstrated resolution of clot within the arterial portion of the graft. A palpable thrill and pulse were present at the completion of the procedure. Both sheaths were removed and purse string sutures placed around the skin entry site. No immediate coplications occurred.
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