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A successful struggle to prolong arteriovenous fistula patency: a case report
C C Gil1, F V Azevedo, M A Ferreira
1Hemodial, Vila Franca de Xira Hemodialysis Center, Portugal. celia.gil@clix.pt
Insights
Vascular access complications in chronic renal failure patients undergoing hemodialysis can be managed. Recurrent central venous stenosis was successfully treated with bypass surgery, maintaining fistula patency.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Adequate vascular access (VA) is crucial for hemodialysis (HD) patients with chronic renal failure (CRF), impacting morbidity and mortality.
- VA patency relies on prompt identification and management of complications by nephrologists and vascular surgeons.
- Venous stenosis is a primary cause of VA thrombosis, necessitating early detection and intervention.
Purpose of the Study:
- To report a case of recurrent central venous stenosis in a hemodialysis patient.
- To illustrate the successful management of complex VA stenosis with bypass surgery.
- To highlight the long-term efficacy of surgical correction for persistent venous stenosis.
Main Methods:
- A clinical case report of a 90-year-old patient with CRF on maintenance HD.
- Management of recurrent central venous stenosis following percutaneous angioplasty (PTA).
- Surgical correction using bypass grafting for refractory venous stenosis.
Main Results:
- The patient experienced recurrent central venous stenosis despite previous PTA.
- Bypass surgery successfully corrected the stenosis, restoring adequate blood flow.
- The original vascular access fistula remained functional and patent for two years post-surgery.
Conclusions:
- Bypass surgery is an effective option for managing recurrent central venous stenosis in hemodialysis patients.
- Timely surgical intervention can preserve vascular access function and improve patient outcomes.
- Multidisciplinary collaboration between nephrologists and vascular surgeons is key for optimal VA management.
Abstract:
An adequate vascular access (VA) significantly determines the morbidity and mortality of chronic renal failure (CRF) patients on maintenance hemodialysis (HD). VA patency depends on the early identification of complications and its management by the nephrologists and vascular surgeon. Venous stenosis accounts for the majority of thromboses, but its early detection followed by either percutaneous angioplasty (PTA) and/or surgical correction will improve fistula patency. We present the clinical case report of a 90-year-old patient with recurrent central venous stenosis after PTA that was corrected with bypass surgery. Two years after surgery the original fistula is still used showing no signs of access dysfunction.
