Intentional Occlusion of the Brachial Artery in Arteriovenous Fistula Ruptured Treated with Merit Wrapsody Covered Stent: A Case Report

We present a case report on the off-label use of the Merit Wrapsody® covered stent for the treatment of an Intentional occlusion of the brachial artery in arteriovenous fistula. A female patient with a previous brachiobasilic arteriovenous fistula was admitted with a cut and bruise wound on the left arm (bathroom stall), which evolved into basilic vein laceration and acute hemorrhagic shock. The patient was then subjected to an arm tourniquet to prevent acute bleeding, which led to acute brachial artery occlusion. The patient was submitted to an endovascular approach with thrombectomy with Indigo System and then an implant of a Merit Wrapsody 8x125mm covered stent within the brachial artery and concomitant resection of the venous segment and skin containing the cut-bruise wound + venous reconstruction. The patient evolved very well with complete resolution of the acute trauma and complete arteriovenous fistula salvage in a 3-year follow-up. This device typically indicated for use in hemodialysis access, was successfully employed to correct an occluded artery. This case highlights the feasibility and potential advantages of this endoprosthesis in arterial settings beyond its original indication.