Creation of a Successful Transposed Antecubital Radiocephalic Arteriovenous Fistula in Patient with Known Ipsilateral Modified Radical Mastectomy, Postoperative Radiation, and Proximal Central Venous Occlusion.

Native arteriovenous fistula (AVF) placement in patients with ipsilateral mastectomy and radiation has been avoided because of concerns regarding central venous outflow obstruction. To our knowledge, only 3 such cases have been reported. We present a patient with bilateral mastectomies and right-sided radiation therapy presenting for vascular access in the setting of multiple failed AVF in her left upper extremity and infected-groin catheter, central catheters, and axillary loop graft. We created and superficialized a radiocephalic AVF in her right upper extremity in the setting of central vein occlusion and robust collaterals which remains patent and has been cannulated successfully.