TITLE: Outcome of tibio-saphanous arteriovenous fistula in patients with failed upper extremity dialysis access: A report of two cases.

ABSTRACT： Arteriovenous fistulas (AVF) are the preferred access for hemodialysis in patient with end stage renal disease. Usually, distal vessels of upper limb are preferred. There are situations in which the upper limb cannot be a site for AVFs or graft as in cases of bilateral central venous stenosis or with exhausted sites in upper limb. In these cases, lower limb AVF can be considered. Tibial-saphanous (ankle) fistula should be the preferred site over femoral AVF/graft following the principle of distal to proximal. Also, femoral AVFs are associated with more ischemic and infective complications. The present report describes successful hemodialysis in two patients with tibial-saphanous fistula a site rarely used as an option for HD access. Hemodialysis for over 1 year in one patient and 6 months in the other portrays the success of this approach.

SOURCE: Mandwar M, Seth A, Sharma A, et al. Outcome of tibio-saphanous arteriovenous fistula in patients with failed upper extremity dialysis access: A report of two cases[J]. J Vasc Access, 2021 :11297298211001164. DOI: 10.1177/11297298211001164.

摘要： 动静脉内瘘（AVF）是终末期肾脏疾病患者进行血液透析的首选途径。通常，上肢的远端血管是优选的。在某些情况下，如双侧中央静脉狭窄或上肢血管耗竭，上肢不能成为AVF或移植物的部位。在这些情况下，可以考虑下肢AVF。遵循股骨远端至近端的原则，胫-隐（踝）内瘘应优先于股骨AVF /移植物。而且，股骨AVF与更多的缺血性和感染性并发症相关。本报告介绍了两名胫-隐内瘘患者的成功血液透析，该部位很少用作HD通路的选择。一名患者进行了1年以上的血液透析，另一例进行了6个月的血液透析，证明了这种方法的成功。

启发：动静脉内瘘方式构建方式有很多，有效的血流量和可用的穿刺段血管就可形成可用的动静脉内瘘。