Dissection in a superficialized brachial artery for hemodialysis access: a case report

Abstract Background Superficialization of the brachial artery is an alternative vascular access strategy for selected hemodialysis patients for whom conventional access options are limited. Dissection of a superficialized brachial artery (SBA) used for dialysis access has rarely been described, and its management is not well established. Case presentation A 76-year-old man with end-stage kidney disease due to diabetic nephropathy underwent right brachial artery superficialization and maintenance hemodialysis via the superficialized artery. During routine cannulation, bedside duplex ultrasonography incidentally suggested a localized arterial dissection, despite the absence of local symptoms. Contrast-enhanced computed tomography revealed a focal dilatation of the SBA with an intraluminal thrombus. Hemodialysis was temporarily performed using a right internal jugular venous catheter to avoid cannulation of the suspected lesion. Duplex ultrasound showed preserved distal perfusion, and a flap-like structure with a mural thrombus and caliber irregularity near the antecubital fossa; the presumed entry site was approximately 2 cm proximal to the antecubital fossa. After confirming the feasibility of proximal cannulation under ultrasound guidance, the catheter was removed, and hemodialysis was continued using an adjusted puncture site approach. Conclusions This case suggests that bedside duplex ultrasound can be used in the early detection of arterial wall pathology in SBA access; and in selected patients with preserved distal perfusion and non-flow-limiting localized lesions, an ultrasound-guided conservative approach with repeat ultrasound assessment during hospitalization may allow the safe continuation of hemodialysis.