title: Collaborative Approach to the Creation of an Arteriovenous Fistula on a US Navy Hospital Ship.
abstract: Early creation of arteriovenous fistulas (AVFs) decreases morbidity and mortality in patients with end-stage renal disease and is the standard of care in the United States. However, this procedure is frequently not accessible in low- and middle-income countries (LMICs). We present the first reported case of successful AVF creation as part of a humanitarian assistance mission. The patient was a 51-year-old male with diabetes, hypertension, and end-stage renal disease on hemodialysis via a temporary dialysis catheter. Preoperative assessment and patient selection were coordinated with the host nation (HN) nephrologist and dialysis team. The visiting surgical team provided education on AVF anatomy, complications, and cannulation techniques to the HN dialysis team. A left brachiocephalic AVF was created under regional anesthesia performed by the visiting surgeon and anesthesiologists. There were no postoperative complications, and the AVF was matured and accessed successfully by the HN dialysis team 7 weeks after creation. Performing AVFs as part of humanitarian assistance missions has the potential to significantly reduce morbidity and mortality in LMICs.
authors.affiliation: 1 Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Thompson
authors.affiliation: 2 Colonial War Memorial Hospital, Suva, Rewa, Fiji.
authors.forename: Amrish
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: 1 Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Stehman
authors.affiliation: 1 Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Hanling
authors.affiliation: 1 Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Casey
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D003299:Cooperative Behavior; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D005367:Fiji; D006801:Humans; D033183:Interdisciplinary Communication; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009326:Naval Medicine; D000072104:Nephrologists / Q000193:education; D064647:Nephrology Nursing / Q000193:education; D010348:Patient Care Team; D012066:Relief Work; D006435:Renal Dialysis; D012767:Ships; D014481:United States
keywords: Pacific Partnership; arteriovenous fistula; hemodialysis access; humanitarian assistance; low- and middle-income countries