Ulnar-basilic fistula (UBF) is an autogenic vascular access option for hemodialysis (HD) first reported in 1967. However, only a few reports dealing with its complications and survival rates have been published in the literature. In the present work the results of 61 UBFs done in 60 adult patients on chronic HD are reported. Forty UBFs were created as primary access and the remaining 21 UBF as secondary access after: (a) thrombosis of an ipsilateral radiocephalic fistula (RCF) in 6 cases, (b) thrombosis of a contralateral RCF in 7 cases, and (c) thrombosis of a brachiocephalic fistula in 2 cases. No episodes of surgical complications, arterial steal, or ulnar nerve damage were observed. Five UBFs thrombosed within the first week after surgery. The 1-, 3-, and 5-year unassisted survival rates were 70.9%, 67.7%, and 57.3%, respectively, which were significantly higher than those reported previously. The inclusion of UBF in routine access plans is recommended.

We describe a case of brachiocephalic fistula vein wall dissection (VWD) occurring in a 36-year-old female hemodialysis patient. Unlike subcutaneous or subfascial infiltrations for which the mechanism is blood extravasation, VWD seems to be due to disruption of the fistula vein layers caused by misplacement of the outflow (venous) needle bevel. In this setting, the pressure of the dialysis blood pump acts as the driving force of the dissecting column, extending it proximally. Gray-scale and color Doppler sonography proved to be very useful in the differential diagnosis of VWD, particularly with thrombosis of the fistula. Sonography also helped us decide when to resume cannulations.

Central vein occlusion (CVO) is not uncommonly observed after hemodialysis (HD) catheter placement and it may prevent subsequent ipsilateral arteriovenous (AV) access creation. Right internal jugular vein catheterization (RJVC) appears to be the insertion site with the lowest incidence of CVO, but little is known about the incidence of CVO following left internal jugular vein catheterization (LJVC). We report on four patients with left innominate vein occlusion after LJVC who developed severe arm swelling after ipsilateral AV access creation. In three of the four cases swelling appeared 12-26 months after access creation, and in the fourth, swelling developed immediately after surgery while the catheter was still in place. Two patients underwent access ligation and in the remainder the arm swelling improved either spontaneously or after LJVC removal. LJVC is not as safe as RJVC as an insertion route for HD catheter placement in terms of CVO frequency.

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