A novel radial artery to radial vein arteriovenous fistula creation technique for long-term dialysis access

Abstract

In patients with chronic renal failure progressing toward the need for renal replacement therapy, establishment of permanent dialysis access is paramount to long-term survival. Prior studies have demonstrated the importance of creation of a direct arteriovenous fistula (AVF) in patients with adequate vasculature, beginning in the nondominant upper extremity. The standard outflow veins are the forearm cephalic vein, upper arm cephalic vein, and upper arm basilic vein. Some investigators have successfully used the transposed brachial vein in select patients. For patients with insufficient native vasculature in the nondominant upper extremity, the use of either synthetic arteriovenous grafts in the nondominant upper extremity or the use of the dominant upper extremity is required. An arteriovenous graft poses a higher risk of infection and thrombosis compared with an AVF. We present a case in which a transposed distal radial artery to radial vein AVF was created as an alternative to graft or brachial vein use due to insufficient standard outflow veins. The AVF remains patent 2 years after creation and is being successfully used for hemodialysis. This novel strategy represents a creative autologous alternative to synthetic grafts for patients who require permanent hemodialysis access but lack superficial venous anatomy for traditional AVF creation.