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Updated: Jan 28, 2026

A Modified Technique for Arteriovenous Fistula Construction in Rabbits
Published on: February 10, 2023
Upper extremity distal dual bypass enables arteriovenous fistula construction in a critical limb ischemia
Tsukasa Nakamura1, Kiyokazu Akioka2, Shuji Nobori1
1Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-Prefecture, Japan.
Background:
Arteriovenous fistula (AVF) trouble in a dialysis patient sometimes results in severe forearm ischemia.
Case Presentation:
We present the case of 27-year-old man with severe steal syndrome complained of AVF malfunction. There was a condition where an upstream artery of AVF is occluded and AVF is maintained by regurgitation from the palmar arch with ischemic digits. The patient underwent distal dual bypass: proximal to peripheral artery arterioarterial and arteriovenous bypasses and brachial arterioplasty. His skin perfusion pressure improved from 17 to 90 mmHg with enough quantity of blood: 250 ml/min for hemodialysis.
Conclusions:
In severe steal syndrome cases, it is often observed that proximal artery is occluded and AVF inflow was supplied from palmar circulation and collateral vessels. Distal dual bypass is effective to re-establish digital circulation and repair AVF malfunction simultaneously in PAD patients.
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