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Case Report: Simultaneous iliac vein bovine pericardial patch venoplasty and creation of PTFE lower limb AV fistula graft for rescue vascular access.

Research paper by Lewis L Meecham, Owain O Fisher, George G Kirby, Richard R Evans, Pauline P Buxton, Jocelyn J Legge, Sriram S Rajagopalan, John J Asquith, Arun A Pherwani

Indexed on: 18 Jul '16Published on: 18 Jul '16Published in: Annals of Vascular Surgery



Abstract

We present a case of external iliac vein patch venoplasty to accommodate rescue vascular access via a PTFE loop arterio-venous fistula Graft (AVG) for a patient with multiple central venous stenoses.A 35 year old female with anti-glomerular basement membrane antibody disease required rescue vascular access for haemodialysis. Repeated occlusion and/or thrombosis of long term central venous access canulae, to facilitate dialysis, had caused stenosis of brachiocephalic veins; right external iliac vein and occlusion of the left common iliac vein. A previous right Brachio-basilic fistula had occluded within 1 year. No other upper limb options for Arterio-venous fistula (AVF) were available. A right external iliac vein bovine patch angioplasty concurrently with a PTFE AV graft between common femoral artery and common femoral vein was performed to restore venous patency and allow rescue dialysis access.At 3 years follow up the fistula remains widely patent with 2 litres/min flow rates and no recurrent stenosis to the treated iliac vein. She has not required any further surgical or interventional radiological procedures to maintain fistula or central venous patency.Central venous stenosis or occlusion is common for patients requiring dialysis, especially those with multiple previous long term central venous cannulations. If restriction of outflow is present AVF may fail. Venous patch angioplasty in these cases is a successful technique, al- lowing AVF formation and long term patency.Central venous stenosis can be treated successfully with patch venoplasty to accommodate AVF/AVG formation for rescue vascular access; this is a potentially lifesaving intervention for patients requiring dialysis.