Preoperative situation

This case illustrates a low-flow situation of a Cimino fistula on the left forearm with a juxta-anastomotic stenosis. Transit Time Flow Measurement (TTFM) and High-frequency Ultrasound Imaging (HFUS) served as completion control.

Intraoperative situation

Intraoperative imaging showed that the radial artery was calcified and it was decided to proximalize the anastomosis to preserve enough fistula length. In addition, a significant side branch was ligated. Image 1 shows a transverse view of the juxta-anastomotic stenotic segment of the fistula vein. The initial flow in the stenotic segment of the fistula vein was measured using a 4mm TTFM probe as shown in image 2.

Completion Control:

Completion control with TTFM ensured a significant flow increase. The final flow measurement at the fistula vein using a 7mm TTFM probe can be seen in image 3.

Completion control with HFUS of the fistula vein after proximalization of the AV anastomosis shows an open lumen as seen in image 4.

The video shows the whole procedure in more detail.

Case Attachments

Image 1

Image 2

Image 3

Image 4

Video