title: Ankle fistula as the last resort for vascular access: case report and literature review.
abstract: OBJECTIVE
  For the majority of patients with end-stage renal failure, renal replacement therapy in the form of dialysis offers the only means of life prolongation. Survival times on haemodialysis have improved, and consequently, patent vascular access is required for an increasing period of time. Upper extremity options for arteriovenous placement are increasingly being exhausted, leading to creation of fistulae in the lower extremities.
  
  
  METHODS
  We describe the management of a patient with superior vena cava obstruction requiring haemodialysis in whom venous access options were becoming very limited. An ankle fistula was formed by anastomosing great saphenous vein (GSV) to dorsalis pedis.
  
  
  CONCLUSIONS
  The long-term patency of lower limb fistulae remains unclear. An ankle fistula preserves precious venous capital in patients who have no remaining options in the upper extremities for haemodialysis access. Furthermore, it allows for proximal revision if necessary. This serves to prolong the time spent dialysing through native fistulae, with their reduced complications and greater cost-effectiveness.
authors.affiliation: 1 Department of Surgery, Addenbrooke's Hospital, Cambridge - UK.
authors.forename: Mingzheng A
authors.initials: MA
authors.lastname: Goh
authors.forename: Jason M
authors.initials: JM
authors.lastname: Ali
authors.forename: Regin
authors.initials: R
authors.lastname: Lagaac
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Pettigrew
mesh_terms: D000842:Ankle / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D006435:Renal Dialysis; D012501:Saphenous Vein / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency