P1370unpopular Solutions for Vascular Access Difficulties in Hemodialysis Patients: A Case Series

Abstract

Background and Aims Vascular access remains a significant challenge for patients on chronic hemodialysis (HD) and often requires creative thinking to preserve and construct durable long-term access. While AVFs continue to remain the gold standard for vascular access, HD access remains an ongoing challenge for surgeons and patients. The cases This report is about 4 ESRD patients on chronic hemodialysis with multiple closed A-V fistulas (left and right radiocephalic then left and right brachiocephalic). Also, they suffered from catheter related blood stream infection (CRBSI) when central lines were inserted so the vascular sureon had to find solutions for them. First patient was 36-year old hemodialysis patient since 1995 2ry to posterior urethral valve. In 1994, he sought renal transplantation from his motivated brother who was the only available living related donor but unfortunately the surgeon discovered a congenital anomaly in the donor side during surgery. So the patient was maintained on hemodialysis. After multiple thrombosed AVF and recurrent episodes of CRBSI with central lines, the vascular surgeons inserted a synthetic graft on left chest wall between axillary artery and axillary vein 3 years ago and it is well functioning with efficient dialysis. The 2nd case (figure 1) is a 42-year old graft failure patient since 2005 and In view of high PRA, 2nd renal transplantation was not an option. After multiple thrombosed AVF and recurrent episodes of CRBSI with central lines, the vascular surgeons created a new fistula in lower extremities between right great saphenous vein and common femoral artery 2 years ago and it is still functioning. The 3rd case (figure 2) is about 14-year old child who received renal allo-transplantation from his father 8 years ago. Now, he is on chronic hemodialysis. First, he underwent peritoneal dialysis. But he suffered from recurrent peritonitis, so he was shifted to hemodialysis. Unfortunately, he suffered from CRBSI with catheters and multiple AVF were thrombosed. So, vascular surgeons performed arterio-arterial synthetic graft using right subclavian artery which is well functioning over 2 years. The 4th case (figure 3) is about 43-year old graft failure case on chronic hemodialysis with widespread thrombosis and difficult central line fixation. Also,AV fistulas had short survival. So, vascular surgeons decided to create AVF in lower extremities between right greater saphenous vein and superficial femoral artery 2 years ago. The patient after that received warfarin and the graft is functioning well till now. Conclusion Hemodialysis access remains an ongoing challenge for surgeons and patients lives.