Hemodialysis arteriovenous fistula created from the posterior tibial artery and a saphenous vein branch

摘要

Vascular access is the dialysis patient's "lifeline." Clinical practice guidelines for vascular access state that the access should be placed in the upper extremities when possible. An arteriove-nous fistula (AVF) in the lower extremity is not a reported option. There are few reports of the relative frequency or patency rate of AVFs in the lower extremity, including case reports.A 50-year-old woman initiated hemodialysis therapy in 2003. Several surgeries were performed on both upper extremities to create AVFs and arteriovenous prosthetic grafts (AVGs), but the AVFs and AVGs did not persist. She therefore was started on peritoneal dialysis therapy in 2007. Thereafter, continuing peritoneal dialysis therapy became difficult due to infection. In March 2011, she re-initiated hemodialysis therapy with a tunneled cuffed catheter. However, catheter-related bacteremia developed. In July 2011, we decided to manufacture a right-ankle AVF. In the ankle, the posterior tibial artery and large saphenous vein are located about 5 cm apart, so the artery and vein were designed in the shape of a bypass using these branches (Fig 1).