PT  - JOURNAL ARTICLE
AU  - Vaughan Washco
AU  - Sesank Mikkilineni
AU  - Stephen Morse
AU  - Jonathan G. Owen
TI  - The Will to Live: Preservation of a Forearm Loop Arteriovenous Graft via Development of Median Cubital Venous Collateral Circulation
DP  - 2015 Jun 20
TA  - Ochsner Journal
PG  - 180--182
VI  - 15
IP  - 2
4099  - http://www.ochsnerjournal.org/content/15/2/180.short
4100  - http://www.ochsnerjournal.org/content/15/2/180.full
SO  - Ochsner J2015 Jun 20; 15
AB  - Background Forearm loop arteriovenous grafts most commonly fail because of stenosis, with thrombosis at the venous anastomosis. Treatment begins with identification of the stenotic lesion causing thrombosis, followed by either a percutaneous method using thrombolytic agents with possible balloon angioplasty and mechanical evacuation or surgical thrombectomy.Case Report We present a case of thrombosis in a forearm loop graft with successful percutaneous thrombectomy. Preservation of this access site was only possible because of an unusual finding of collateral circulation, with the median cubital vein acting as a conduit to the basilic vein.Conclusion The choice of surgical vs percutaneous methods for treating a thrombosed graft remains controversial. Yet the success rates of pharmacologic thrombolysis and the percutaneous approach are comparable to those of surgical thrombectomy. Our case of successful percutaneous thrombectomy illustrates the value of preserving the median cubital vein whenever possible in the placement of forearm arteriovenous grafts.