Rerouting the outflow tract of an autologous arteriovenous fistula to restore distal limb return flow in a hemodialysis patient: A case report

Distal limb ischemia and venous hypertension are rare but serious complications of arteriovenous fistula (AVF) used for hemodialysis. Managing such combined arterial-venous pathology while preserving vascular access remains challenging. A 62-year-old man on long-term hemodialysis presented with swelling, pain, and dark discoloration of the left hand fingers. Duplex ultrasonography revealed cephalic vein occlusion, venous hypertension, and retrograde flow from the distal radial artery, consistent with AVF-associated venous hypertension. The patient underwent venous flow reconstruction and AVF outflow rerouting. The postoperative course was uneventful, with rapid improvement in hand perfusion, resolution of swelling, and sustained AVF patency suitable for dialysis use.