Reviving A Arteriovenous Fistula after Ligation, Using the PerforatorSystem

Abstract

The key to this case presentation is based on the particular anatomy of the patient. This 34-year-old CKD patient had a previous ulnar-basilic AVF in the left limb witch was used for dialysis for a few months and was ligated shortly after the renal transplant, in the same year. The AVF was done in a one stage fashion with a short transposition segment as a personal preference of the previous surgeon. Also, the patient had an axillary level brachial artery bifurcation. This made possible reviving the old AVF circuit using the cubital fossa perforator, through the comitant radial vein, and into the basilic vein. The newly executed AVF was patent at 2 weeks when the patient came in for the whole basilic vein transposition.

There are not many cases in vascular access literature of old basilic vein AVFs revived through the deep venous system.

By using a short graft to construct a graftula that will supply the previous AVF, or using a long segment graft to create a forearm loop or a brachial to axillary AVF, the chances of graft to vein anastomosis stenosis and thus the need for another procedure. Using the patient’s anatomy for creating/reviving a native AVF on the non-dominant upper arm, we can prolong the need for a graft AVF.