On (b)(6) 2017, a gore® propaten® vascular graft (6mm x 40cm, straight, standard wall, non-stretch, non-tapered) was implanted in the patient's right upper arm as a conduit.On (b)(6) 2017, the patient presented with significant right arm swelling.A physical exam revealed a thrill and 2+ right upper extremity edema.An ultrasound was performed and a 6fr sheath was used during the angiography.Two areas of stenosis were identified.The first was a 60% stenosis of the axillary vein proximal to the venous anastomosis.The second was at the distal brachiocephalic vein, which was 90% stenosed.The patient was diagnosed with central venous stenosis of the graft (intensity: moderate).Both areas of stenosis was crossed with a bentson wire from the inferior vena cava.An angled glide catheter was inserted into the inferior vena cava which was then exchanged for an amplatz wire.Angioplasty was then performed of the brachiocephalic vein stenosis using an 8 mm and a 10 mm balloons.It was reported that this area of stenosis likely was from having his catheter in position, secondary to the 60% stenosis, which was causing backfill of the arm.In order to direct all the flow back centrally to prevent further arm swelling, a 6 mm x 10 mm covered stent (unknown manufacturer) was placed over this area.The blood flow was good and inflow was rapid.The patient was reported to be feeling well after the procedure.Patient was discharged the same day with the central venous graft stenosis resolved.
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