A 65-year-old woman, identified as Sa, has been battling end-stage renal failure. To create vascular access for dialysis, she underwent three arteriovenous fistula (AVF) surgeries in both arms. However, due to her age and prolonged dialysis, these fistulas narrowed or became chronically blocked. Multiple medical facilities diagnosed widespread peripheral vascular narrowing and severe damage, making it difficult to find a suitable location for a new access point.

At Tam Anh General Hospital in Hanoi, Dr. Do Trung Dung of the Cardiothoracic and Vascular Surgery Department, explained that if a suitable location for a new AVF couldn't be found, a central venous catheter would be necessary. However, catheters are recommended only for short-term use due to the risk of infection, thrombosis, and blockage. External catheters also cause discomfort and restrict movement, potentially leading to serious complications with long-term use.

Dr. Dung discovered a usable section of the basilic vein deep within Sa's left arm. Instead of a standard AVF procedure, the surgical team employed a vein transposition technique, connecting the basilic vein to the brachial artery and then bringing the vein closer to the skin surface for dialysis needle access.

Post-surgery, Sa is undergoing regular dialysis through the new AVF with improved health and positive outcomes.

Doctor examining a dialysis patient. *Illustrative photo: Tam Anh General Hospital*

According to Dr. Dung, vascular access is crucial in treating end-stage renal failure. The most recommended and durable access is an AVF, created by directly connecting an artery to a superficial vein. AVFs allow for high blood flow, reduce infection risk, and last longer than central venous catheters. Creating these access points requires experienced doctors and advanced equipment like ultrasound machines, C-arms, and DSA machines.

"Choosing the right location for the initial AVF is vital," Dr. Dung stated, adding that AVF creation should prioritize locations furthest from the heart with suitable veins while preserving unused vessels for long-term dialysis needs.

Patients with chronic kidney disease should receive early advice and take measures to protect their veins, maintaining optimal vascular health for future dialysis access. This includes limiting intravenous infusions and blood draws in the arm intended for AVF creation. After AVF placement, patients should avoid blood pressure measurements, blood draws, or infusions in that arm, keeping the surgical site clean and dry. Any swelling, pain, or unusual symptoms during dialysis warrant immediate medical attention.

Ly Nguyen

*The patient's name has been changed.