Interesting Cases

Abstract

There is a subset of patients in which the fistula upper body and/or outflow veins are chronically occluded. These peripherally occluded (Fig. 29.1), blind-ended AV accesses drain through multiple accessory veins ultimately into the central circulation. An AV access becomes dysfunctional due to lack of straight line outflow which can manifest as, or be associated with prolonged bleeding, high venous pressures, poor clearances due to recirculation, swelling of the extremity, and even thrombosis of the access. When conventional recanalization techniques fail, the definitive treatment has been surgery to salvage these accesses, which has its own associated morbidity and mortality. The technique described here percutaneously creates a new anastomosis of the occluded outflow to a patent adjacent outflow vein. This percutaneous technique is feasible, safe, and easily done in the outpatient setting. It is an excellent option to salvage these dying accesses.