The role of a distal forearm perforating vein and deep vein system in supporting patency of a snuffbox fistula – A case report

The purpose of this manuscript is to describe the clinical course of a 66-year-old patient with chronic kidney disease due to focal segmental glomerulosclerosis in whom an access arteriovenous fistula was created in the anatomical snuffbox. At discharge, the fistula thrill was normal. Two months later, a duplex examination revealed previously unrecognized obstruction of the mid-forearm segment of the cephalic vein; flow was maintained by a perforator into the deep venous system, which returned blood to the upper arm cephalic vein above the occlusion. A second, subsequent radiocephalic anastomosis was performed in the wrist to augment flow. The fistula was successfully cannulated after 12 weeks of maturation.