title: Use of the subcutaneous venous network of the forearm to create an arteriovenous fistula.
abstract: The reconstruction of vascular access in patients with kidney allograft failure is a challenging problem. A case of a 62-year-old man with transplanted kidney insufficiency is described. The patient was initially dialyzed with a wrist radial-cephalic arteriovenous fistula. In the post-transplantation period, the enormously dilated venous part of the anastomosis was ligated and the part of the vein suspected of being the source of bacteremia was excised. The man was referred to our department due to kidney allograft failure for vascular access creation. During preoperative assessment, we unexpectedly found a soft thrill on the forearm. Doppler ultrasound confirmed fistula patency, although the blood supply was not sufficient to perform dialysis. Angiography showed the blood flow from the radial artery to the cephalic vein, through a complicated vessel system consisting of inter alia a dilated vein of the subcutaneous venous network. We successfully used this vein as the vascular access outflow for fistula recreation. In conclusion, making use of veins of the subcutaneous venous network of the forearm for creation of a native fistula should be considered in selected cases.
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gołębiowski
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Letachowicz
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Letachowicz
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kusztal
authors.affiliation: Department of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Garcarek
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Strempska
authors.affiliation: Faculty of Dentistry, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Wacław
authors.initials: W
authors.lastname: Weyde
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
mesh_terms: D001164:Arteriovenous Fistula / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005542:Forearm / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods
keywords: Subcutaneous venous network; arteriovenous fistula; dialysis