Endovascular Balloon Treatment of a Failing Arteriovenous Fistula. A Case Report.

Abstract

BACKGROUND: Arterio-venous (AV) fistula is created for patients requiring renal replacement therapy (hemodialysis and hemofiltration). A failing Ass-V fistula requires urgent treatment to keep it patent. Understanding the simple tips and tricks will contribute to the quality of life for the patient with end-stage renal disease and reducing radiation dose to the operator. CASE SUMMARY: A 77 year old male with end-stage renal disease, hypertension and coronary artery disease. He has been on regular haemodialysis after A-V fistula (left forearm) was constructed in 2013. He presented with 2 weeks history of A-V fistula occlusion. Examination was essentially normal. Serum sodium=136mmol/l, potassium=5.5mmol/l urea=100mg/l, creatinine=3.5mg/dl. The Doppler scan showed 50 % stenosis just proximal to the anastomosis with calcification. Percutenous arteriography and venography was done with non-compliance balloon (3x12mm) up to 24 atm . The post procedure venography showed restoration of flow across the fistula. CONCLUSION: Endovascular treatment of a failing A-V fistula can be life saving. The simple tips and tricks of using the groin route, reducing the concentration of contrast and maneuver devices may contribute to safety and reduce radiation to the operator.