Critical haemodialysis vascular access

Case contributed by Khalid Alhusseiny
Diagnosis certain


Pain in upper limb during hemodialysis sessions.

Patient Data

Age: 40 years
Gender: Female

Injection of the contrast media was done through the already placed dialysis cannula at the left cephalic vein in the distal arm.

A left brachiocephalic arteriovenous fistula (AVF) is seen where there is anastomosis between the cephalic vein and the superficial division of a highly bifurcating brachial artery.

A small pseudoaneurysm with a narrow stalk is seen related to the mid-1/3 of the cephalic vein at the left arm.

Two focal significant stenoses extending for +/- 1.5 cm are seen involving the left cephalic vein along its course in the proximal 1/3 of the left arm.


End-to-side brachiocephalic AVF. Color Doppler ultrasonography revealed a relatively low volume flow along the brachial artery reaching 229 ml/min.

Annotated images


Annotated image showing site of AVF, cephalic vein and highly bifurcated brachial artery.

Case Discussion

Decreased volume flow through the feeding artery of hemodialysis access is a prognostic factor for failure of the arteriovenous fistula. Critical hemodialysis vascular access can occur due to stenosis or thrombosis of the feeding or draining vessels.

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