AB140. SOH24AB_130. The forty-year-old fistula: a case report highlighting novel arteriovenous connections in a functioning yet disused fistula

Background: While there is no universally agreed-upon approach to managing arteriovenous fistulas (AVFs) in kidney transplant recipients, a growing body of evidence underscores the potential long-term complications associated with leaving AVFs intact for extended periods. These chronic side effects can include left ventricular hypertrophy, pulmonary hypertension, increased infection risk, and potential impairment of the transplanted kidney.

Case Description: This is a case report describing a unique presentation of a long standing radiocephalic fistula in a successfully transplanted patient. This case highlights a cascade of disease processes that stem from thrombotic changes in the arterialised venous system that ultimately manifested as a markedly oedematous upper limb that greatly affected our patient’s quality of life. The intra-operative realisation that several new angiogenic connections between the radial artery and cephalic vein had formed has never been commented on in previous literature. With an uneventful post operative period this simple intervention that required a one-night stay in hospital has noticeably increased our patient’s quality of life, improved the survival likelihood of his transplant, as well as protecting him against the cardiac burden of a long term functioning fistula.

Conclusions: It is the author’s belief that this firsthand example, in conjunction with the growing body of evidence that’s highlighting the local and systemic burden of long-term fistulas, that the decision as to whether an individual should have their fistula ligated be on a case-by-case basis and be under constant review until international guidelines are set.

Keywords: Fistula; guidelines; ligation; thrombosis; transplant