The past and the future of vascular access surgery: Creation of percutaneous arteriovenous fistula using Ellipsys vascular access system in a patient with previous ipsilateral Scribner-shunt.

BACKGROUND

Sixty years after the first description of Scribner-shunt, and 54 years after publication of the first radio-cephalic arterio-venous fistula (AVF), endovascular percutaneous AVF (pAVF) was introduced. We report a successful case of Ellipsys-pAVF creation and use for hemodialysis in a patient with a previous ipsilateral Scribner-shunt.

CASE: A 72-year old female patient with chronic kidney disease (CKD), previous right-sided Scribner-shunt and kidney transplant, underwent a successful creation of right-sided Ellipsys-pAVF. The procedure time was 12 min with intraoperative brachial artery volume flow of 720 ml/min. At 39 days, an ultrasound-guided balloon-angioplasty of the outflow cephalic vein stenosis was performed. Cannulations were started 41 days after the creation of pAVF. No additional interventions were required during the follow-up of 258 days with last follow-up volume flow of 1400 ml/min.

CONCLUSIONS

This is the first report of the creation of pAVF in a patient with previous "traumatic" ipsilateral placement of a Scribner-shunt. It allows the creation of a small anastomosis in very short time, which can be successfully used for hemodialysis treatment on the same day, if necessary, and reduces the expected risk of high-flow AVF with associated peripheral steal and cardiac outcomes (especially in a patient with cardiomyopathy such this one).