Unanticipated late maturation of an arteriovenous fistula after creation of separate graft access
Arteriovenous fistulas are the gold standard for hemodialysis access, but successful maturation of a fistula is unpredictable. We discuss this highly variable process through a unique case of an arteriovenous fistula that matured over a year after initial placement without any prior surgical intervention. A 69-yearold African American male with history of hypertension, coronary artery disease, and end-stage renal disease on hemodialysis with an immature autogenous brachial-cephalic upper arm access fistula and a thrombosed prosthetic brachial-basilic loop access graft presented to interventional radiology for thrombolysis and angioplasty. Post angioplasty, a venogram in the left upper arm revealed both a patent graft and a patent fistula that matured over a year after initial placement. The patient’s initial fistula was then successfully used for hemodialysis. The patient’s age, ethnicity and comorbidities increased his risk for primary fistula failure. We provide insight into why the fistula had delayed maturation in the context of this patient’s unique risk factors and comorbidities.