AV fistula are the lifeline of patients with kidney failure. They are the most preferred and safe way of performing dialysis. However some times they do run into problems. An elderly gentleman who was both diabetic and hypertensive with kidney failure was dialysing through a fistula on his right arm. He started to complain of pain and swelling in the arm during dialysis and the swelling would not come down even after dialysis. He was referred to the vascular surgery team.
This gentleman had swollen arm with decreased thrill or vibration in the fistula. He also had catheter insertion done before for dialysis in his right neck. The patient was diagnosed with a blockage in the veins in his chest draining the fistula.
The gentleman was taken up for an angiogram which showed the blockage in his chest called central vein occlusion/ stenosis.
He was succesfully treated for this by balloon angioplasty and placement of a stent
The gentleman was relieved of his symptoms and is on regular follow up.