Presentation
Pain in upper limb during hemodialysis sessions.
Patient Data
Injection of the contrast media was done through the already placed dialysis cannula at the left cephalic vein in the distal arm.
A left brachiocephalic arteriovenous fistula (AVF) is seen where there is anastomosis between the cephalic vein and the superficial division of a highly bifurcating brachial artery.
A small pseudoaneurysm with a narrow stalk is seen related to the mid-1/3 of the cephalic vein at the left arm.
Two focal significant stenoses extending for +/- 1.5 cm are seen involving the left cephalic vein along its course in the proximal 1/3 of the left arm.
End-to-side brachiocephalic AVF. Color Doppler ultrasonography revealed a relatively low volume flow along the brachial artery reaching 229 ml/min.
Annotated image showing site of AVF, cephalic vein and highly bifurcated brachial artery.
Case Discussion
Decreased volume flow through the feeding artery of hemodialysis access is a prognostic factor for failure of the arteriovenous fistula. Critical hemodialysis vascular access can occur due to stenosis or thrombosis of the feeding or draining vessels.