Vascular access becomes useless after a successful renal transplantation. We report a 59-year-old male, kidney recipient, who presented with pain in the left index finger two weeks after radiocephalic arteriovenous fistula (RCAVF) ligation. The tip of the index finger was white and the skin perfusion pressure was 20 mmHg. The Doppler sound of the radial artery around the RCAVF was weak, suggesting an occlusion of the radial artery. Angiogram showed filling defect corresponding to the occluded segment of the radial artery around the RCAVF. Arterial reconstruction of the radial artery was performed using a cephalic vein as a vein graft. The cephalic vein of the RCAVF was ligated at 2 cm proximal from the radial artery and was found to be filled with a thrombus. This suggested that the radial artery thrombosis was due to turbulent flow at that site.
The ischemia resolved gradually. After a follow-up of 17 months, the patient remained asymptomatic. When we need to occlude AVF after kidney transplantation, an appropriate ligation site should be considered to avoid turbulent flow and constriction of the radial artery.
