Persistent Median Artery As A Cause Of Nonmaturing AV Fistula.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Nephrology

Background:

• Radiocephalic arteriovenous fistula (AVF) creation is a standard procedure for end-stage renal disease (ESRD) patients requiring hemodialysis.
• Nonmaturing AVFs can result from various factors, including anatomical variations and technical complications.
• Accurate pre-procedural assessment is crucial for successful AVF creation and long-term patency.

Observation:

• A 68-year-old male with ESRD presented with a nonmaturing left radiocephalic fistula.
• Diagnostic arteriography identified an unusual distal forearm arterial anatomy, including a dominant common interosseous artery presenting as a persistent median artery.
• The arterial anastomosis was performed on this variant artery.

Findings:

• The patient underwent angioplasty for an arterial anastomosis lesion.
• During subsequent balloon angioplasty of the common interosseous artery, a 30 cm segment of the 0.018 guide wire fractured and required retrieval with a snare device.
• This complication occurred in the context of managing an unusual arterial anatomy.

Implications:

• Awareness of distal forearm arterial anomalies, such as a persistent median artery, is critical for vascular access surgeons.
• Thorough pre-operative arterial mapping can prevent procedural complications and improve AVF outcomes.
• This case underscores the importance of anticipating and managing both common and rare complications in AVF procedures.