Access Excision More often than you think, we are confronted with the dilemma of what to do with an unused fistula. Most often, the patient has had a renal transplant and would like to get rid of the “lumps” in his arm, and most often we advise the patient not to abandon a perfectly good asymptomatic fistula. You never know how long a transplanted organ READ MORE…
Part one: Acute and occlusive thrombosis In addition to rupture and bleeding, aneurysmal fistulas are prone to thrombosis which occurs in two forms: (1) acute and occlusive, or (2) indolent and laminated. Laminated clots were previously presented in a Michigan Vascular Access Facebook post (Sept. 27th, 2016) Acute and occlusive thrombosis An aneurysmal fistula is prone to clot for the same reasons that any AV READ MORE…
Back in March, I promised to share the results of my review of 2016 – so many new patients, how many fistulas, how many grafts, so on and so on. I create fistulas, place grafts, do procedures to force fistulas to mature, do a lot of maintenance thrombectomies and venoplasties, stent placements, management of central stenosis, and operative revisions. There is a lot to talk READ MORE…
“Distinguishing between ‘good’ aneurysms, and ‘bad’ aneurysms – five signs” In my previous post (May 23rd), I stated that most aneurysmal fistulas, though overgrown and perhaps startling, are not dangerous and can continue to be cannulated for dialysis. It goes without saying, though, that they draw attention and suspicion. In an extreme case, a patient with a wrist fistula dating back to 2001, comes to READ MORE…
A pacemaker-associated central occlusion complicating a transposed basilic fistula. A 68-year-old male patient was seen for dialysis access. He was dialyzing via a right IJ permacath and had a left sided pacemaker present for approximately a year. A venogram of the right upper extremity showed a usable basilic vein and clear central vessels with a right IJ permacath and the pacemaker leads coming in from READ MORE…
A case of digital ischemia secondary to vascular access (steal) treated with banding The patient was a 44-year-old male, long-term diabetic and former smoker who had been on dialysis just over a year via a left two-stage transposed basilic fistula placed in a local hospital. He reports some degree of coldness and pain in the hand below the access, and was advised by his local READ MORE…
Our definition of “Firehose fistula” A “Firehose fistula” is our term for a fistula that carries more flow than is desirable for the average patient. On the bottom end, a fistula must deliver at least 600 cc per minute of flow to allow effective dialysis, and probably closer to 1000 cc/min to prevent recirculation. We know that access flows less than 600 cc/min are associated READ MORE…
Wrist Fistula – Surprisingly, Ready to Use after the first Post-Operative Visit This wrist fistula was created approximately two weeks before the image was taken, and it was surprisingly ready to be used at the first post-operative visit. On the average, our wrist fistulas take about two months to be usable, but in this case the vein was large, the radial artery was capable READ MORE…
Case report: A PICC line-associated central occlusion complicating a brachiocephalic fistula. A 72-year-old right-handed female patient was seen for dialysis access. She was dialyzing via a right IJ permacath for three months, had a BMI of 33, and had adequate vessels for a left brachiocephalic fistula, though the vessels were smaller and deep. There was no history of previous left arm swelling, left sided permacath, READ MORE…
This transposed basilic fistula was created in one stage from a 5mm basilic vein. Although there is disagreement amongst vascular access surgeons about whether basilic transpositions should be done in one or two stages (the moving and tunneling of a vein to a new position under the skin is traumatic, and the veins do better after the move if they are larger and tougher after READ MORE…
