Percutaneous Creation of a Venous Anastomosis in a Native Hemodialysis Fistula

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The advantages of autogenous fistulas over grafts and catheters for vascular access in hemodialysis are well recognized and include lower rates of all-cause mortality and infection and significantly decreased total access costs. However, a substantial number of fistulas will never mature and are eventually abandoned. Percutaneous techniques are increasingly used to salvage fistulas to enable maturation and use. The authors report on a patient with a thrombosed immature brachiocephalic dialysis fistula with an occluded outflow vein, in whom fistula function was salvaged through creation of a percutaneous vein-to-vein anastomosis. This technique adds to the growing armamentarium of interventional therapies for occluded venous outflow in hemodialysis access sites.