Radio‐cephalic fistula recovered with drainage to forearm basilic vein

Abstract

Dysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.

Radio‐cephalic arteriovenous fistula recovered with drainage through the brachial vein

“…This solution allows the patient to keep RC‐AVF in functioning, not to place central venous catheter, and increase the patency of the current fistula. It also allows preserving the vascular network for future accesses (brachial and basilic vein); arterialization of the brachial vein and contributing to increase its diameter . The brachial vein has currently a 3.7 mm diameter, which can ease its future transposition in a one stage …”

“…The radio‐cephalic arteriovenous fistula (RC‐AVF) is the ideal vascular access and should be considered the first choice for hemodialysis patients . However, RC‐AVF cannot be created in all patients due to arterial network problems, decrease/absent venous network, or both …”

“…Typically, RC‐AVF has higher permeability and fewer complications compared with other fistula locations . Some dysfunctions of this type of fistula are very complex and difficult to solve.…”

“…Patients with complex AVF need a careful analysis of the vascular network with ultrasound, to identify the most adequate and appropriate solution for each access. The superficial veins can be used to resolve RC‐AVF complications, especially the forearm basilica vein . Deep veins may be a good solution to maintain the AVF patency.…”

“…1,2 However, RC-AVF cannot be created in all patients due to arterial network problems, decrease/absent venous network, or both. 3 Typically, RC-AVF has higher permeability and fewer complications compared with other fistula locations. 3 Some dysfunctions of this type of fistula are very complex and difficult to solve.…”