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Semin Dial. 2015 Sep-Oct;28(5):552-7. doi: 10.1111/sdi.12363. Epub 2015 Mar 19.

Persistent Median Artery As A Cause Of Nonmaturing AV Fistula.

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Sierra Nevada Nephrology Access Center, Reno, Nevada.
Kansas Nephrology, Wichita, Kansas.
Angiocare, Vascular and Interventional Nephrology, Tucson, Arizona.
University of Florida, Jacksonville, Florida.
Western Surgical Group, Reno, Nevada.
Department of Medicine, University of Nevada, Reno, Nevada.


A 68-year-old right handed male with End-Stage Renal Disease with a left radiocephalic fistula created 8 months ago was referred for the evaluation of a nonmaturing access. Patient had an arterial anastomosis lesion that underwent successful angioplasty. Diagnostic arteriogram of the AV access extremity revealed the presence of a short radial artery and dominant common interosseous artery manifesting as a persistent median artery in the distal forearm and was anastomosed to the fistula and then continues as the median-ulnar superficial arch in the palm. Balloon angioplasty of the common interosseous artery led to a complication when the distal 30 cm of the 0.018 guide wire fractured and had to be retrieved using a snare device. In addition to anticipating and treating the common complications of vascular access procedures, it is also important to be aware of the anomalies of the distal forearm arterial anatomy and perform a detailed arterial evaluation prior to creating the arterio-venous anastomosis.

[Indexed for MEDLINE]

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