Access of dysfunctional arteriovenous fistulas via outflow vein side branches

摘要

The patterns of stenosis in dysfunctional arteriovenous (AV) fistulas (AVFs) are not as predictable as in synthetic AV grafts. Accessing of AV fistula venous side branches has the potential to provide bidirectional access to the fistula and may reduce the need for multiple fistula puncture sites via the use of the technique described here. Institutional review board approval was not required for the present report.A 58-year-old man with stage 5 chronic kidney disease who underwent creation of a left radiocephalic AVF 4 months earlier was referred to the interventional radiology unit for evaluation of delayed maturation. The AVF was pulsatile, but no thrill was detected on palpation. There was no arm swelling or edema. Initial ultrasound (US) examination revealed moderate narrowing of the juxta-anastomotic fistula. A prominent venous side branch was identified in the mid-forearm, joining the cephalic vein at an approximately 90° angle (Fig 1).