Fig. 2

Failure to advance a 018″ guidewire viz. local antegrade and retrograde accesses due to focal obstruction (arrow) in the midportion of the graft correlating with area of delamination seen on ultrasound (a). Transfemoral access used to selectively catheterize the left brachial vein and contrast injection confirmed position within the graft vein anastomosis (arrow) (b). Four to eight millimeters microsnare via antegrade micropuncture sheath used to externalize the glidewire from the arm creating a through and through wire access (arrow) (c). Persistent flow defect is seen in the mid-portion of the graft (arrow) after Balloon angioplasty and platelet plug embolectomy of the graft-artery anastomosis demonstrating the area of delamination which needs to be grafted (d)