Salvage of a thrombosed radio-cephalic fistula by anastomosis to brachial comitans vein: A case report

Late thrombosis of radiocephalic arteriovenous fistulas (RCAVFs) is most commonly associated with inadequate venous outflow, and when superficial veins are unavailable or unsuitable, surgical salvage options remain limited. We report a case of complete RCAVF thrombosis caused by perforating vein occlusion in the setting of absent effective central venous drainage due to a sclerotic, non-patent cephalic vein of the arm. Surgical salvage was achieved by thrombectomy of the efferent vein followed by creation of a latero-lateral anastomosis with a brachial comitant vein. The fistula was immediately functional and successfully cannulated for hemodialysis using the original distal puncture sites. Although brachial comitant veins are well described as primary autogenous access conduits, their use as a secondary venous outflow for salvage of a thrombosed RCAVF has not been previously reported. This technique may represent a feasible and effective salvage strategy in selected patients.