Surgical method for correcting fistulous vein stenosis in hemodialysis: A clinical case

Abstract

Permanent vascular access is crucial for the effective management of patients with end-stage kidney disease (ESKD) undergoing hemodialysis. The arteriovenous fistula (AVF) remains the preferred access due to its long-term patency, with an initial survival rate of over 50% at five years. However, once stenosis becomes hemodynamically significant (>70% luminal narrowing), it leads to reduced blood flow, increased venous pressure, and a greater than 50% risk of thrombosis, necessitating timely intervention. Endovascular techniques for restoring venous patency, such as angioplasty and stenting, are costly and require specialized equipment, which limits their availability in Ukraine.

Here, we present the case of a 72-year-old patient (O.) with ESKD due to hypertensive and diabetic nephropathy. The patient developed a 70% stenosis of the fistula vein in the right anterior elbow region. To restore vascular access function, an interpositional autovenous shunt was created using a conduit from the great saphenous vein of the lower limb. The postoperative assessment confirmed a well-functioning AV shunt, allowing a dialysis blood flow rate of up to 300 ml/min. The patient was followed up for six months, with no complications observed.

This case highlights the efficacy of interpositional autovenous shunting as an accessible and effective alternative to endovascular interventions for AVF stenosis. Personalized decision-making and careful preoperative assessment are essential to optimizing outcomes for hemodialysis patients.