Persistent Median Artery As A Cause Of Nonmaturing AV Fistula

• Published in: Seminars in dialysis 2015-09, Vol.28 (5), p.552-557
• Main Authors: Jalandhara, Nishant, Balamuthusamy, Saravanan, Skaria, Sunil, Jalandhara, Priyanka, Hansen, John, Waiganjo, Nancy
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Arteriovenous Fistula - diagnosis; Arteriovenous Fistula - etiology; Arteriovenous Shunt, Surgical - adverse effects; Brachiocephalic Veins; Humans; Kidney Failure, Chronic - therapy; Male; Radial Artery; Renal Dialysis - adverse effects
• ISSN: 0894-0959; 1525-139X
• DOI: 10.1111/sdi.12363

A 68‐year‐old right handed male with End‐Stage Renal Disease with a left radiocephalic fistula created 8 months ago was referred for the evaluation of a nonmaturing access. Patient had an arterial anastomosis lesion that underwent successful angioplasty. Diagnostic arteriogram of the AV access extremity revealed the presence of a short radial artery and dominant common interosseous artery manifesting as a persistent median artery in the distal forearm and was anastomosed to the fistula and then continues as the median‐ulnar superficial arch in the palm. Balloon angioplasty of the common interosseous artery led to a complication when the distal 30 cm of the 0.018 guide wire fractured and had to be retrieved using a snare device. In addition to anticipating and treating the common complications of vascular access procedures, it is also important to be aware of the anomalies of the distal forearm arterial anatomy and perform a detailed arterial evaluation prior to creating the arterio‐venous anastomosis.