Brakiosefalik Av Fistüllerde Proksimal Sefalik Ven Darlıklarında Sefalik Ven ile Aksiller Ven Arasında Venovenostomi ile Onarım

The stenosis at the proximal end of the arteriovenous fistula (AVF) can cause dysfunction and can lead to thrombosis of the vascular access. Performing angioplasty at the antecubital region can repair the proximal stenosis in the forearm AVF. However, it is technically difficult to expose the most proximal part of cephalic vein in upper arm AVF. We present a case who had a brachiocephalic AVF with isolated proximal cephalic vein obstruction without central vein stenosis. The patient was referred to our center for inadequate creatinine clearance even though she continued to have complete hemodialysis with adequate blood withdrawal. The fistulogram demonstrated isolated proximal cephalic vein stenosis at the level of drainage to the central vein. The patient had thrombectomy and the end of cephalic vein was anastamozed to the brachial vein through a new tunnel. There was satisfactory blood flow through the cephalic vein after diversion of blood flow to brachial venous system from occluded cephalic vein. Hemodialysis patients who have recirculation and inadequate clearance at their brachiocephalic arteriovenous fistula should have fistulography to identify isolated cephalic vein stenosis. Venovenostomy at the upper arm to bypass the proximal saphenous stenosis is both technically easy and an effective approach.