Gross anatomical analysis of complications associated with the site of arteriovenous fistula placement

Abstract

In the present study, we examined one cadaver of patient who had an arteriovenous (AV) fistula to perform gross anatomical examination of complications associated with AV fistula placement: vasodilation, stenosis, and aneurysm formation. Significant vasodilation, stenosis, and aneurysm formation were noted in arteries and veins proximal to the site where anastomosis of the radial artery and the cephalic vein was created. Vasodilation was likely caused by high-pressure blood flow from the radial artery caused by AV anastomosis that was created to place the AV fistula.

Aneurysms likely formed as a result of vascular congestion in veins proximal to the AV anastomosis, caused by repeated punctures within a small region. Lastly, stenosis of the cephalic vein likely occurred as small aneurysms shifted from the site of anastomosis due to high-pressure blood flow.

Our findings suggest that the following conditions are important and must be carefully monitored in order to appropriately maintain AV fistulas: 1) avoid performing punctures in the same area or within a limited region to prevent aneurysm formation and vasodilation, 2) prevent excessive backflow of blood, and 3) prevent vascular congestion of blood returning to the heart as a result of reduced muscular strength of the forearms and palms.