title: Simultaneous Iliac Vein Bovine Pericardial Patch Venoplasty and Creation of PTFE Lower Limb Arteriovenous Fistula Graft for Rescue Vascular Access.
abstract: BACKGROUND
  We present a case of external iliac vein patch venoplasty to accommodate rescue vascular access via a polytetrafluoroethylene loop arteriovenous fistula graft (AVG) for a patient with multiple central venous stenoses.
  
  
  METHODS
  A 35-year-old female with anti-glomerular basement membrane antibody disease required rescue vascular access for hemodialysis. Repeated occlusion and/or thrombosis of long-term central venous access cannulae, to facilitate dialysis, had caused stenosis of brachiocephalic veins: right external iliac vein and occlusion of the left common iliac vein. A previous right brachiobasilic fistula had occluded within 1 year. No other upper limb options for arteriovenous fistula (AVF) were available. A right external iliac vein bovine patch angioplasty concurrently with a polytetrafluoroethylene AV graft between common femoral artery and common femoral vein was performed to restore venous patency and allow rescue dialysis access.
  
  
  RESULTS
  At 3-year follow-up, the fistula remains widely patent with 2 L/min flow rates and no recurrent stenosis to the treated iliac vein. She has not required any further surgical or interventional radiological procedures to maintain fistula or central venous patency. Central venous stenosis or occlusion is common for patients requiring dialysis, especially those with multiple previous long-term central venous cannulations. If restriction of outflow is present, AVF may fail. Venous patch angioplasty in these cases is a successful technique, allowing AVF formation and long-term patency.
  
  
  CONCLUSIONS
  Central venous stenosis can be treated successfully with patch venoplasty to accommodate AVF/AVG formation for rescue vascular access; this is a potentially lifesaving intervention for patients requiring dialysis.
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Meecham
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK. Electronic address: owainfisher@doctors.org.uk.
authors.forename: Owain
authors.initials: O
authors.lastname: Fisher
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: George
authors.initials: G
authors.lastname: Kirby
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Evans
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Buxton
authors.affiliation: Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Legge
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Sriram
authors.initials: S
authors.lastname: Rajagopalan
authors.affiliation: Department of Interventional Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: John
authors.initials: J
authors.lastname: Asquith
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Arun
authors.initials: A
authors.lastname: Pherwani
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods*; D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002417:Cattle; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D010496:Pericardium / Q000637:transplantation*; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene