Reconstruction of a Thrombosed Aneurysmal Radio-Cephalic Arteriovenous Fistula with a Tubular Bovine Pericardial Conduit

We report the case of a 44-year-old man with end-stage kidney disease (ESKD) who has been on chronic hemodialysis via a radio-cephalic arteriovenous fistula (RC-AVF) for one year. The patient arrived at the emergency department due to an inability to continue dialysis through the AVF. Clinical and ultrasound exams reveal an aneurysm in the cephalic vein, measuring 2.3 cm (cm) in diameter and 5 cm long, located in the middle third of the forearm, with intraluminal thrombosis. A surgical procedure is planned to exclude the aneurysmal segment and reconnect the vein, using a graft made from a bovine pericardium patch. Immediately after surgery, a thrill is detectable, and ultrasound shows a flow rate of 651 mL/min. On the second day, dialysis is performed through the distal cephalic vein segment under ultrasound guidance, avoiding the median forearm zone. At one month, the fistula remains functional, with no signs of thrombosis or stenosis. The bovine pericardium tubular graft has shown complete integration. This case supports the feasibility, safety, and potential advantages of using a tubularized bovine pericardial graft as an alternative conduit for RC-AVF reconstruction in select patients. However, further studies on larger cohorts and with extended follow-up are necessary to validate its reproducibility and long-term patency.