First attempted cannulation of this woman’s recently placed brachiocephalic AVF was unsuccessful:
Fistulogram was done. Can this fistula be salvaged or should it be abandoned? If you try salvage, how many procedures will it take? Will you use a covered stent, drug coated balloon, stent, or only PTA?
Submitted by Dr. Robert Jones of Birmingham, UK
The patient is a 75-year-old female with a one-year-old right arm ulnar artery – ulnar concomitant vein Wavelinq fistula. She underwent a basilic vein transposition 5 months later. The AVF was used successfully for dialysis. More recently access flow has decreased to 300 ml/min with difficulties to dialyse. The angiogram from the brachial artery is depicted in the image.
The antecubital superficial veins anatomy is best understood by an archetypal roadmap of single veins with the five essential veins: the perforating vein, the medial cubital vein (MCV), the cephalic vein, the median basilic vein (MBV), and the basilic vein. The perforating vein is present and passes lateral to the proximal radial artery in more than 85% of cases. Both available techniques require the ability to approximate an artery and a vein for the devices to create an anastomosis.
Case submitted by: Dr. Paul Gibbs, UK
The 49 year old patient on home dialysis (two previous transplants and highly sensitised) presents with a painful pulsatile swelling at of upper arm PTFE graft. US scanning (figure 1) and fistulogram (figure 2) confirm the presence of a large false aneurysm at the arterial button hole site.