Left-sided high-flow arteriovenous hemodialysis fistula combined with a persistent left superior vena cava causing...

Area of Science:

• Cardiology
• Vascular Surgery
• Nephrology

Background:

• End-stage renal disease (ESRD) patients often require hemodialysis access.
• Arteriovenous fistulas are a common form of hemodialysis access.
• Congenital anomalies like persistent left superior vena cava (PLSVC) can complicate vascular access.

Observation:

• A case is presented involving a left-sided arteriovenous fistula and a PLSVC.
• The combination led to potential hemodynamic consequences.
• Coronary sinus (CS) dilation was noted, raising suspicion for PLSVC.

Findings:

• Echocardiography is vital for identifying PLSVC in ESRD patients undergoing hemodialysis access assessment.
• PLSVC can alter normal venous drainage and affect fistula hemodynamics.
• CS caliber is an important indicator for suspecting PLSVC.

Implications:

• Early detection of PLSVC through echocardiography can prevent adverse hemodynamic events.
• Understanding the interaction between PLSVC and AV fistulas is crucial for patient management.
• This case highlights the need for thorough pre-procedural evaluation in complex vascular access cases.