The use of arteriovenous fistula for cancer chemotherapy administration in hemodialysis patients

Abstract

Vascular access preservation is fundamental in hemodialysis patients to ensure dialysis adequacy, patient survival, and quality of life. Chemotherapy administration typically requires central venous access devices, which are associated with significant complications and potential compromise of future vascular access options. We describe two chronic hemodialysis-dependent patients in whom intravenous chemotherapy was administered via a pre-existing mature autogenous arteriovenous fistula (AVF). In both cases, chemotherapy was delivered through AVF puncture using a peripheral catheter on non-dialysis days by experienced dialysis nursing staff. No procedural complications, including local trauma, infection, extravasation, or access dysfunction, occurred. Dialysis adequacy and AVF blood flow remained stable during follow-up. These cases demonstrate the technical feasibility and safety of chemotherapy infusion via mature AVFs in selected patients. They suggest that this strategy may preserve central veins, maintain long-term vascular access integrity and avoid unnecessary invasive procedures. Further studies are needed to define selection criteria and long-term outcomes.