Abstract
Background:
Native arteriovenous fistulas remain the preferred vascular access for hemodialysis. However, critically unfavorable venous anatomy can impede their successful creation. Poor-quality or small-sized distal veins with areas of focal stenosis and thickened venous segments compromise the feasibility of placing a standard arteriovenous fistula or lead to fistula nonmaturation or malfunction, requiring adjuncts such as primary angioplasty or staged-balloon assisted maturation.
Methods:
This is a report of a single-stage technique using a short strip of bovine pericardium, tapered at the venous half of the patch in a “boat-shaped” configuration and flared at the arterial half of the patch, which is tubularized to create a cylindrical conduit and bridge an otherwise healthy vein with a focal stenosis to the target artery. With this onlay-tubularized bovine pericardial patch, the diseased segment can be enlarged and a smooth “neovein” created while preserving the autogenous cannulation segment.
Results:
The technique is illustrated in the case of a 56-year-old patient with immunoglobulin A nephropathy and a distal basilic vein focal defect. Immediate postoperative results were positive with strong bruit and thrill while follow-up duplex within 2 months showed excellent venous dilation and a flow exceeding 600 mL/min. Patency at 12 months remains intact.
Conclusions:
It is appropriate to use this technique in patients with adequate inflow and outflow, but with focal vein stenoses or short, thickened vein segments that preclude the use of a standard AVF. This hybrid approach, combining principles of patch venoplasty and bovine pericardial bypass grafting, may be used as a salvage option in selected patients with focal venous stenotic lesions considered for native arteriovenous fistula creation.
Keywords
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