Arteriovenous Fistula Research Articles

Teaching NeuroImage: Medullary Edema Due to Dural Arteriovenous Fistula: A Potentially Characteristic Imaging Finding.

Teaching NeuroImage: Medullary Edema Due to Dural Arteriovenous Fistula: A Potentially Characteristic Imaging Finding.

Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A 15-Year Overview.

Distal forearm arteriovenous fistulas (AVFs) for hemodialysis (HD) include radiocephalic fistulas (RCFs) and ulnar-basilic fistulas (UBFs). However, due to the unique anatomical peculiarities of the latter approach, UBFs are only established in a limited subset of patients undergoing vascular access procedures. This study aimed to present a retrospective case series detailing the creation of UBFs, emphasizing both the technical challenges and clinical outcomes associated with this approach. We conducted a retrospective review of UBFs created between 2008 and 2023. Data collected included patient demographics, comorbidities, patency, functionality, and outcomes. Adequate blood flow and personalized Kt/Vurea levels were prerequisites for defining UBF functionality for HD. Among 253 patients receiving HD, 82.2% had an AVF, with only 3.3% (n = 5) of the 150 distal AVFs functional for HD being UBFs. In this series, a total of 11 UBF fistulas were created, with nine patients experiencing an immediate thrill. Among those with UBF failure, three patients were aged > 85 years, and three had concurrent diabetes mellitus, peripheral vascular disease, and ischemic heart disease. The survival rate in the UBF group correlated with the duration of dialysis in the three patients for whom the UBF was the sole AVF, with one patient achieving a remarkably prolonged period of > 10 years. No incidences of ischemia, hand edema, or ulnar nerve lesions were noted. While the difficulties experienced in achieving functional UBFs for HD are highlighted in this long-term perspective, its safety and durability make it a viable option in managing an increasingly comorbid patient population.

Renal artery embolization before cryoablation using radial artery through an abandoned hemodialysis fistula

In patients with end-stage renal and current or planned arteriovenous fistula, trans-radial access is listed as a relative contraindication to preserve future hemodialysis (HD) fistula sites. Herein, we report a case of trans-radial trans-fistula arterial access in the setting of an abandoned HD fistula with preserved flow.

What are the effects of surgical thrombectomy or the pulse spray technique compared with mechanical thrombectomy for treating people with thrombosed hemodialysis arteriovenous fistulas or grafts?

What are the effects of surgical thrombectomy or the pulse spray technique compared with mechanical thrombectomy for treating people with thrombosed hemodialysis arteriovenous fistulas or grafts?

A uremic patient with autogenous arteriovenous fistula developed tension blisters after initial puncture

Tension blisters usually occur in the presence of local swelling or excessive pressure. Tension blisters after puncture injury are relatively rare in uremic patients who use autogenous arteriovenous fistula (AVF) for hemodialysis treatment. In this report, the patient we reported developed tension blisters after the initial puncture injury. Arterial CTA revealed obvious stenosis of the right subclavian vein and the patient was diagnosed with venothoracic outlet syndrome (VTOS). In this case, the occurrence and development of tension blisters after dialysis puncture injury were observed. Furthermore, the etiology, treatment measures, and methods for preventing the occurrence of tension blisters are illuminated to further improve the quality of vascular access.

PREDICTING HIGH FLOW ARTERIOVENOUS FISTULAS AND CARDIAC OUTCOMES IN HEMODIALYSIS PATIENTS.

Heart failure is common in patients receiving hemodialysis. A high flow arteriovenous fistula (AVF) may represent a modifiable risk factor for heart failure and death. Currently, no tools exist to assess the risk of developing a high flow AVF (>2000 mL/min). The aim of this study was to use machine learning to develop a predictive model identifying patients at risk of developing a high flow AVF and to examine the relationship between blood flow, heart failure, and death. Between 2011 and 2020, serial AVF blood flows were measured in 366 prevalent hemodialysis patients at two tertiary hospitals in Australia. Four prediction models (deep neural network, and 3 separate tree-based algorithms) employing age, first AVF flow, diabetes, and dyslipidemia were compared to predict high flow AVF development. Logistic regression was used to assess the relationship between AVF blood flow, heart failure, and death. High flow AVFs were present in 31.4% of patients. The bootstrap forest predictive model performed best in identifying those at risk of a high flow AVF (AUC 0.94, sensitivity 86%, specificity 83%). Heart failure prior to vascular access creation was identified in 10.2% of patients with an additional 24.9% of patients developing heart failure after AVF creation. Long-term mortality after access formation was 27%, with an average time to death after AVF creation of 307.5 ± 185.6 weeks. No univariable relationship using logistic regression was noted between AVF flow and incident heart failure after AVF creation or death. Age, flow at first measurement >1000 mL/min, time to highest AVF flow, and heart failure predicted death after AVF creation using a general linear model. Predictive modelling techniques can identify patients at risk of developing high flow AVF. No association was seen between AVF blood flow rate and incident heart failure after AVF creation. In those patients who died, time to highest AVF flow was the most important predictor of death after AVF creation.

Impact of aspirin on the outcome of upper limb AVF placement in hemodialysis patients: Discontinuation or not.

There is limited research on the consumption of aspirin and its effects on bleeding during arteriovenous fistula (AVF) placement surgery and associated complications in end-stage renal disease (ESRD) patients. Regarding the potential risks imposed on cardiac patients by discontinuing aspirin, the aim of the study was to determine whether aspirin should be discontinued prior to AVF placement surgery. This prospective study was carried out at two referral medical centers from 2023 to 2024. The patients were included as 30 patients who routinely took 80 mg of aspirin daily and 30 patients who did not take aspirin. The primary outcomes included the amount of blood loss, and the secondary outcomes included AVF success and maturation time. The amount of bleeding was assessed by the ΔHb (Hb1-Hb2), ΔHCT (HCT1-HCT2), and intraoperative hemorrhage volume. Aspirin consumption did not significantly affect any of the examined parameters, including operation duration, hemoglobin decrease, hematocrit decrease, intraoperative hemorrhage, AVF success rate, maturity time, need for blood transfusion, postoperative bleeding, hematoma and thrombosis, hospitalization, and re-Operation (p > 0.05). Aspirin did not have any significant or negative effects across any of the parameters examined. Based on the findings of this study, there is no need to discontinue aspirin in patients prior to upper limb AVF placement surgery, but further studies are recommended.

A Spontaneous Arterial Venous Fistula in a Patient on Hemodialysis: Case Report.

Arteriovenous fistula is an abnormal connection between arteries and veins occurring usually following surgery, trauma, catheterization, or local procedures. Spontaneous arteriovenous fistulas are a rare clinical entity with very few cases reported in the literature with unclear mechanisms. We present a case report of a 54-year-old Ethiopian female with known chronic kidney disease on hemodialysis for 2 years thrice a week who presented with progressive pulsatile right thigh mass of 7 months duration in the absence of trauma, catheter insertion previously, or surgery. The arteriovenous fistula was confirmed by computed tomography angiography and it was intervened with open surgery with no complication.

IMPORTÂNCIA DO AUTOCUIDADO COM A FÍSTULA ARTERIOVENOSA EM PACIENTES DE HEMODIÁLISE: UMA REVISÃO INTEGRATIVA

Chronic Kidney Disease is characterized by a slow and progressive decline in kidney function, with hemodialysis being an essential treatment in advanced stages. For the success and effectiveness of hemodialysis treatment, an effective vascular access is necessary. Considered the gold standard for providing efficient treatment with greater comfort and longevity, the arteriovenous fistula is preferable, but its maintenance requires proper self-care practices. Objective: To understand how the lack of self-care can impact complications associated with the arteriovenous fistula in hemodialysis patients. Method: This is an integrative review, in which articles were searched through the Virtual Health Library (VHL) databases (Scielo, Lilacs, and Medline) and PubMed, using combinations of the following indexed Health Sciences descriptors: ("self care" OR care) AND "Renal Dialysis" AND "Arteriovenous Fistula" AND Nursing. Results: The results highlight the need for educational interventions and practices aimed at specific self-care for the preservation of the arteriovenous fistula. Conclusions: A deficit in self-care practices related to the arteriovenous fistula is recognized. The relevance of the nursing professional in nephrology is emphasized, highlighting their central role in promoting self-care for the arteriovenous fistula

Viability of Extracorporeal Membrane Oxygenation Circuits during Arterio-venous Shunting: An Observational Study of ECMO Circuits

Introduction Trial off veno-arterial extracorporeal membrane oxygenation is often performed by diversion of circuit flow through an arterio-venous shunt. Separation from the patient presents an augmented risk for microbiological growth and deterioration of the circuit components and blood circulating within it. It is unclear how long mechanical components and blood circulating within the circuit remain intact during arterio-venous shunting. Methods Following decannulation, the arterial and venous lines were connected simulating an arterio-venous shunt. Flow was maintained at 500 ml/min. Observations at 11 intervals were paired with blood culture, blood gases, chemistry and coagulation studies. Heparin was not provided in two circuits, and four circuits received 30 IU/hour. Results Of six circuits studied, five maintained flows of 500 ml/min for 48 hours. One circuit developed extensive clot after two hours and blood flow ceased. Microbial growth was not detected. Glucose, fibrinogen and platelet levels reduced progressively from the outset. Cell breakdown was evident by four hours (increase in plasma potassium and phosphate) and lactate rose above 6.3 mmol/L at four hours in all circuits. Conclusion Arterio-venous shunting longer than four hours carries a risk of blood decomposition and cell energy pathway depletion. Re-establishing extracorporeal membrane oxygenation support post arterio-venous shunting carries a risk of physiological derangement, given the blood composition changes during arterio-venous shunting. Consideration should be given to an alternate method to assess the physiological stability of patients off extracorporeal membrane oxygenation prior to decannulation. Alternately, consider a crystalloid flush of the circuit to remove decomposed blood if the trial-off exceeds four hours.

Fluid–structure interaction in a follow-up study of arterio-venous fistula maturation

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysed patients. AVF is created surgically using the patient’s artery and vein. Once the connection (anastomosis) is made, the maturation process begins. Studies have shown that most AVFs do not survive beyond one year. This study presents fluid–structure interaction (FSI) modelling of non-Newtonian blood flow through an end-to-side radio-cephalic AVF, investigated weekly during a 15-week follow-up period and 1.5 years postoperatively using ultrasound methods. The aim was to collect qualitative and quantitative data regarding changes in hemodynamics and alterations in the walls of AVF vasculature. Different material properties were assigned to the artery, suture zone (anastomosis), and vein, while the stiffening of the venous arm over time was also modelled. The proposed FSI methodology can be implemented in future follow-up studies involving groups of patients. The main findings revealed: a) counter-rotating vortices in the anastomosis cross-section affecting local pressure conditions; b) different temporal progression of vorticity, shear strain rate, and turbulent kinetic energy and similarity of the temporal progression of WSS obtained under the assumptions of the rigid-walled and FSI; c) a negligible low-WSS zone in the presented thrombosis-free AVF; d) migration of the zone of maximal temporal wall deformation over time.

Single or dual antiplatelet therapy improves one-year arteriovenous graft patency and overall survival

IntroductionFollowing new dialysis access creation there is no consensus on the optimal use of anti-thrombotic therapy. Recent studies have suggested that single antiplatelet therapy may improve hospital mortality as well as patency. The aim of this study was to assess the role of different antiplatelet and anticoagulation therapies on outcomes following dialysis access creation. Material and MethodsA retrospective study was conducted utilizing patients from the Vascular Quality Initiative who underwent AV fistula (AVF) and AV graft (AVG) creation from 2011-2023. Patients who were antiplatelet and anticoagulation naive were separated into four cohorts: no antiplatelet (No APT), single antiplatelet (SAPT), dual antiplatelet (DAPT), and aspirin with anticoagulation (ASA + AC). Univariate Kaplan-Meier (KM) and multivariable regression analyses were conducted to assess overall survival, primary patency, and secondary patency. Results49,980 patients with AVF creation and 12,688 patients with AVG creation were identified. AVG patients had improved 1-year primary patency with SAPT compared to No APT (48% vs 44%, p = 0.03) on KM analysis. No difference on KM analysis was observed for AVF. Regression analysis showed decreased risk of loss of primary patency for AVF (HR 0.90, CI 0.83-0.97, p = 0.009). AVG with SAPT showed decreased risk of mortality (HR 0.80, CI 0.64 – 1.00, p = 0.05) and decreased risk of loss of primary patency (HR 0.80, CI 0.67-0.94, p = 0.009). DAPT also showed decreased risk of loss of primary patency for AVG (HR 0.64, CI 0.43-0.95, p = 0.028). Survival was worse for both AVF and AVG patients on ASA + AC on KM analysis. ConclusionsSingle antiplatelet therapy following access creation improves primary patency for both AVF and AVG, as well as overall survival for those with AVG. DAPT may further improve primary patency in those with AVG. The use of anticoagulation shows no clear benefit and may be harmful, however is more likely to reflect higher risk patients with other co-morbidities. These results suggest that following an AVF one should consider discharging patients on SAPT, and following an AVG one should consider SAPT or DAPT.

Vascular rescue–minimally invasive management of a post-spinal surgery fistulized ilio-iliac pseudoaneurysm: a case report

BackgroundAortoiliac injury after intervertebral disc surgery is an uncommon but potentially fatal complication. This case study emphasizes how crucial it is to identify this uncommon complication, which can manifest itself in a variety of ways, including leg oedema, heart failure, and deep vein thrombosis. This case is unique in that it presents with an uncommon post-spinal surgery complication of fistulized pseudoaneurysm of the common iliac artery and vein. This combination calls for an immediate diagnosis and careful care.Case presentationA 36-year-old female patient presented with progressively worsening orthopnea, accompanied by chest pain and palpitations. Her medical history revealed gradually increasing right lower limb swelling since three months, following a discectomy procedure for the management of lower back pain associated with a herniated lumbar disc at the L5-S1 level. Doppler ultrasonography demonstrated an arterialized flow within the right common iliac vein. Subsequent computed tomography angiography identified a pseudoaneurysm of the right common iliac artery, which had formed a fistulous connection to the right common iliac vein. This uncommon complication was likely attributable to prior disc surgery. The patient received endovascular intervention, which was executed in two primary stages: first, embolization of the right internal iliac artery was performed, followed by the exclusion of the arteriovenous fistula through the deployment of a covered stent graft within the right common iliac artery. The intervention successfully resolved both the pseudoaneurysm and the arteriovenous fistula.ConclusionsThis case report underscores the importance of considering vascular complications in patients presenting with unusual symptoms following intervertebral disc surgery, even after a significant time lapse. While both open surgical and endovascular approaches can yield good results in treating such complications, the endovascular method, as demonstrated in this case, is associated with minimal morbidity. This approach offers a less invasive alternative that can effectively manage complex vascular injuries resulting from disc surgery. Clinicians should be aware of this rare but serious complication to ensure timely diagnosis and appropriate management, potentially improving patient outcomes in similar cases.

The Impact of Surgical Timing on Outcomes in Patients Undergoing Arteriovenous FistulaCreation for Hemodialysis. A Meta-analysis

Background: Arteriovenous fistula (AVF) creation is the preferred method for vascular access in hemodialysis patients, offering better long-term patency, fewer complications, and lower infection rates compared to other options. However, the timing of AVF creation plays a critical role in determining outcomes. This meta-analysis examines the impact of surgical timing on AVF success, focusing on primary failure rates, maturation time, patency, and postoperative complications. Objectives: We sought to evaluate whether the timing of AVF creation impacts outcomes in hemodialysis patients and to provide evidence-based recommendations for clinical practice. Methods: Following PRISMA guidelines, a comprehensive meta-analysis was conducted from major databases (PubMed, Embase, Cochrane) until 2024 that included data. We selected studies based on defined criteria, and assessed for quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Primary failure rates, maturation time, primary and secondary patency and postoperative complications were analyzed as outcomes. Heterogeneity was addressed with random effects models, and subgroup analyses were carried out on the basis of patient characteristics. Results: Early AVF creation (creating an AVF ≥ 6 months prior to dialysis initiation) was shown to reduced primary failure rate by 50%, shortened maturation time by 2 to 3 weeks and increase primary patency rates by up to 35%. Early AVF creation, on the other hand, was also accompanied by fewer postoperative complications, including infection and thrombosis, versus delayed AVF creation. Consistent benefits were seen for different patient profiles in subgroup analyses. Conclusion: Early AVF creation is associated with superior outcomes, including lower failure rates, quicker maturation, and fewer complications. These findings support early AVF as the preferred practice in hemodialysis care, enhancing long-term patient outcomes and quality of care.

Juxta-anastomotic stenosis in the forearm native arteriovenous fistula: Open surgery or angioplasty?

The juxta-anastomotic stenosis (JAS) represents the major complication of arteriovenous fistula (AVF) during the first months after the surgery and the approach to JAS can be surgical or radiological. From 01/02/2016 to 31/12/2020, a total of 976 radiocephalic fistulas have been performed. The 15.9% of AVF was malfunctioned due to JAS. A retrospective analysis was conducted on 156 patients with JAS, in order to compare the primary outcome of surgery and percutaneous angioplasty (PTA) in JAS treatment, in the lower forearm in a follow-up of 24 months. Ninety patients underwent to surgery and 66 to PTA, mean age was 63.43 ± 14.54 and 65.10 ± 15.10 years, respectively. Frequencies of diabetes mellitus and arterial hypertension were similar by groups. Cardiovascular disease was present in 20% of the surgery patients and in 42.4% PTA patients (p = 0.04). The primary assisted patency was 84.4% and 71.1% in the surgery group at 12 and 24 months and 54.5% and 69.6% in the PTA group. The secondary patency at 24 months was 95.6% for surgery group and 96.9% for PTA group, without a statistical significance. During the study period, 10 AVFs (11.1%) showed a restenosis in the surgical group and 14 (21.2%) in the PTA group. This retrospective study suggests a higher restenosis rate after PTA than surgery. However, the statistical analysis shows that the failure rate of the two procedures is comparable. A dedicated multidisciplinary team could represent the goal for a good clinical practice in the treatment of JAS.

MRI-Based Prediction of Macrovascular Causes of Intracerebral Hemorrhage: The MACRO Score.

Although most spontaneous intracerebral hemorrhages (ICHs) are due to cerebral small vessel diseases (SVDs), between 1 in 7 and 1 in 10 are due to a macrovascular cause. Rapid diagnosis has important therapeutic and prognostic implications but sometimes requires digital subtraction angiography (DSA), an invasive procedure which cannot be performed in all patients. MRI provides optimal sensitivity for markers of SVD but was not included in previous risk stratification scores. We aimed to create and validate a risk stratification score for macrovascular causes of ICH including MRI findings to guide diagnosis and further investigations. We pooled data from 2 large observational study cohorts (London/United Kingdom and Graz/Austria) of consecutive patients with ICH who had brain MRI and at least 1 angiographic modality within 90 days of symptom onset. The primary outcome was a macrovascular cause of ICH (arteriovenous malformation/dural arteriovenous fistula, aneurysm, cavernoma, or cerebral venous thrombosis), with the diagnosis based on neurovascular multidisciplinary meetings. Using lasso logistic regression, we built the MRI Assessment of the Causes of intRacerebral haemOrrhage (MACRO) score to assess the probability of a macrovascular cause. We performed internal validation using bootstrapping and external validation in an independent cohort (Bern/Switzerland). We included 1,043 patients with ICH (mean age 66 years, 42% female), 78 of whom had a macrovascular cause (7.5%). The final score includes age (0-39, 40-69, or ≥70), location of ICH (lobar, deep, or infratentorial), and SVD markers on MRI (≥1 microbleed, ≥1 lacune, presence of cortical superficial siderosis, or white matter hyperintensities using the Fazekas scale). The MACRO score showed an optimism-adjusted c-statistic of 0.90 (95% CI 0.88-0.93), superior to existing CT-based scores (p < 0.001). In external validation, the c-statistic was 0.87 (95% CI 0.80-0.94). MACRO scores ≥6 (59.5% of patients) indicated a very low risk of a macrovascular cause (0.2%), while scores ≤2 (9% of patients) indicated a high risk (48.9%). The MRI-based MACRO score shows excellent performance in predicting the likelihood of macrovascular causes of spontaneous intracerebral hemorrhage, making it useful in guiding further investigations. Important limitations include the observational study design and the performance of DSA in a minority of patients.

Pulmonary arteriovenous malformation: not all hypoxemia during COVID-19 is the same

Pulmonary arteriovenous malformation: not all hypoxemia during COVID-19 is the same

Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling.

Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs. The study included 207 patients with 222 CSDAVFs referred for TVCE, all of whom had complete angiographic follow-up over 9 years. Ninety patients (mean age, 65.3 years) with 97 CSDAVFs underwent TVCOE after coiling. Clinical data, angioarchitecture, and outcomes were retrospectively assessed and compared to 125 CSDAVFs treated with TVCE. Key reasons for selecting TVCOE included improvement in immediate complete obliteration (CO) of CSDAVFs (n = 47, 48.5%), presence of cranial nerve palsy (n = 26, 26.8%), residual fistula with persistent pial venous reflux (PVR, n = 22, 22.7%), and redirection of fistula flow to PVR (n = 2, 2.1%). The average volume of Onyx used in TVCOE was 1.7 ml per CSDAVF. The mean coil lengths for TVCOE and TVCE were 143 cm and 228 cm, respectively, with a statistically significant difference (p < 0.05). Immediate digital subtraction angiography showed CO or nearly CO of CSDAVFs in TVCOE and TVCE at rates of 97.9% and 76.8%, respectively, indicating statistical significance in immediate CO (p < 0.05). Transient hemodynamic instability occurred in 81 (90.0%) patients due to Onyx toxicity, and 1 patient (1.1%) experienced hemorrhagic complications during TVCOE. The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate CO. This technique is viable for patients with PVR. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups.

Endovascular Approach to Concurrent Anterior Cranial Fossa Dural AVF and Concurrent Flow-Related Ophthalmic Artery Aneurysm: A Case Study

AbstractDural arteriovenous fistulas (DAVFs) with concurrent flow-related ophthalmic artery aneurysms, particularly intraorbital aneurysms, are rare. Retrograde cortical blood flow and sinus thrombosis heighten the risk of rupture and optic nerve compression, yet treatment strategies remain poorly defined. This study aims to explore effective management for these complex cases. A 66-year-old hypertensive man presented with an acute severe headache, loss of consciousness, and decreased vision in the left eye. Imaging revealed a left frontal intracranial hemorrhage and an anterior cranial fossa DAVF with a left ophthalmic artery aneurysm. Endovascular embolization via the left ophthalmic artery, using a microcatheter distal to the aneurysm and controlled reflux of glue injection (N-butyl cyanoacrylate and lipiodol), successfully treated the DAVF and ophthalmic artery aneurysm. Visual acuity improved to finger counting at 1 foot, with no residual DAVF at 6 months. This case demonstrates that controlled glue embolization is a viable alternative when microsurgery is not feasible due to complex anatomy.

Cephalic to jugular vein bypass surgery of subclavian vein stenosis for arteriovenous fistula salvage in maintenance hemodialysis patients.

Ipsilateral subclavian vein stenosis in a well-functioning upper extremity arteriovenous fistula (AVF) is a significant factor contributing to AVF failure and sometimes swelling of ipsilateral upper extremity. Graft bypass surgery can alleviate outflow tract stenosis in upper extremity AVF, restore function, and efficiently relieve arm swelling. The present study aimed to evaluate patency and postoperative complications after cephalic to jugular graft bypass surgery in patients with upper extremity AVF failure or upper extremity swelling on the same side of the AVF resulting from ipsilateral subclavian vein stenosis. Five patients with upper extremity AVF and ipsilateral subclavian vein stenosis undergoing maintenance hemodialysis were included. Three patients had AVF dysfunction, while two experienced swelling of the arm due to high venous pressure in the AVF. The surgical procedure involved creating a subcutaneous tunnel in the shoulder to connect a 6 mm polytetrafluorethylene (PTFE) graft, from either near the fistula site (n = 3) or at the mid-upper arm cephalic vein (n = 2), to the jugular vein. Graft bypass surgery was successful, and all patients were able to resume hemodialysis postoperatively. Upper extremity edema improved, without any postoperative wound infections, non-healing wounds, steal syndrome, or high-flow AVF leading to heart failure as a complication. Five to 19 months after surgery, the bypass grafts exhibited a primary patency rate of 100%, and vascular access fulfilled the requirements for hemodialysis. Cephalic to jugular vein bypass surgery for upper extremity AVF with ipsilateral subclavian vein stenosis effectively preserved function of the original fistula, and was associated with few postoperative complications.