Unrecognized vascular variation leading to failure of arteriovenous fistula cre...

• Author(s): Marinho, R ; Germano, A ; Gomes, A ; Sousa, M ; Rocha, R ; Fragoso, M ; Pignatelli, N ; Nunes, V
• Date: 2014
• Persistent ID: http://hdl.handle.net/10400.10/1145
• Origin: Repositório do Hospital Prof. Doutor Fernando Fonseca
• Subject(s): Renal dialysis; Hemodynamics; Arteriovenous fistula; Vascular access devices
• Document Type: Conference Object
• Language: English

Description

AIMS OF THE STUDY: To describe the importance of preoperative venous and arterial mapping before choosing the best arteriovenous fistula (AVF) according to the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. METHODS: We describe a case of a successful arteriovenous graft (AVG) creation after the failure of two AVF and a AVG without vascular mapping conducted before the successful surgery. This case was selected among 239 patients between February 2011-January 2014. RESULTS: 52 y woman with postpartum complications that evolved with chronic renal disease was referred from another hospital where a right upper arm brachial-cephalic and a brachial-basilic AVF and a left forearm radial-cephalic AVG were performed but failed due to thrombosis. Then a radial-cephalic AVG also failed in the left forearm. Venous and arterial imaging showed a right sinuous brachial artery with a 4mm diameter and a 0,13l/min flow. The right basilic and cephalic veins couldn´t be characterized due to the extensive thrombosis. The left radial artery had a 2mm diameter and a 0,01l/min flow and the cephalic vein was also thrombosed. Left brachial artery showed a 4mm diameter and a 0,14l/min flow and the basilic vein presented with a good permeability in the upper arm with a 7mm diameter. A left brachial-basilic AVG was successfully performed at our hospital and still being used for hemodialysis. CONCLUSIONS: According to the KDOQI guidelines, the radial-cephalic AVF at the wrist and brachial-cephalic AVF at the antecubital fossa are the first and second access choices being the brachio basilic the third choice. AVG is indicated in absence of no suitable vein for AVF. This case underscores the importance of vascular mapping before surgery to avoid AVF failure and preservation of future access.