157 Failure to improve may require surgical intervention with banding or access correction or ligation. Severe degenerative changes of the graft or overlying skin are present. Skin above the graft is compromised. There is a risk of graft rupture due to poor eschar formation or there is evidence of spontaneous bleeding. Hemodynamically significant stenoses.
Venous stenosis increases the risk of thrombosis.
Moreover, the presence of venous stenosis reduces the efficiency of the dialysis treatment. Therapeutic interventions for hemodynamically significant stenoses reduce the rate of thrombosis and graft loss and prolong the average use-life of the access. When infected, a dialysis AV graft should be treated surgically. An untreated access infection may lead to bacteremia, sepsis, hemorrhage, and death. Degenerative changes that occur within a graft and the overlying skin, including pseudoaneurysm formation with progressive enlargement, can eventually compromise circulation to the skin above the graft.