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논문분류	춘계학술대회 초록집
제목	Artificial blood clot removal that overcomes 3 hurdles (arterial puncture pseudoaneurysm, apex stent-graft, venipuncture pseudoaneurysm)
저자	Heeryong Lee
출판정보	2024; 2024(1):
키워드
초록	CASE A 53-year-old female patient with left forearm loop AVG vessel was due to artificial vessel thrombosis. A 6Fr sheath was inserted into the upper cephalic vein, which is the outflow vein, and dilatation was performed with a 7mm balloon from the axillary vein to the front of the sheath, and the remaining thrombus was removed with a 5.5Fr Fogarty balloon. Afterwards, wiring was performed by turning the direction of the sheath retrograde under ultrasonic guidance. A thrombus was removed from the arterial-artificial vessel anastomosis with a 5.5Fr Fogarty balloon, and then dilatation was performed with a 7mm balloon. The patient had a 6mm stent-graft installed in the apex area at another center, and inward distortion was observed in two places. Many blood clots inside the pseudoaneurysm were not removed from the stenosis area even by squeezing and were attached to the wall, and the stent-graft in particular was difficult to apply physical force to. With the Fogarty balloon filled to 0.75 cc, it was pulled while maintaining maximum pressure, and the operator compressed the pseudoaneurysm with his fingers to expand the contact area between the Fogarty balloon and the thrombus as much as possible. After repeating several times, the thrombus inside the arterial pseudoanerysm moved again into the venous pseudoanerysm through the apex stent-graft. When removing a thrombus from pseudoneurysm through a narrow inlet, the operator repeatedly applied pressure while pulling with a 0.75cc Fogarty balloon. Afterwards, all blood clots were removed and blood flow was restored. Conclusion Large pseudoaneurysms in artificial blood vessels are difficult to remove due to the large amount of thrombus. In this patient, thrombus removal was even more difficult due to the stenosis of the apex stent-graft, but the thrombus was successfully removed using a 5.5 Fogarty balloon and manual compression.
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