Haemodialysis Access Conundrum - Fistula Turndown and Ligation of Branch

Thursday 2014-03-13

Ultimate haemodialysis access solution - twin lumen on one fistula

My arteriovenous fistula turndown and ligation of side branch is scheduled on 18 March, next Tuesday. The fistula is a knotty character. I’m right handed, but my left arm is useless with too many rivers and branches; my right arm is not a straight forward story either.

31 Oct 2013 a fistula was created in my right arm, last Christmas ultrasound showed there’s a twin of them.  Today with naked eye I can see one vein zigzagging like ECG chart and bulging along my right arm, the other vein invisible but I can feel, also bulging under the skin. I can’t discern whether it’s a Danny and Arnnie scenario or an identical twin, when I listen through a stethoscope they sounded similar which means they have equal volume of blood flow. Anyway the doctor decided to ligate the “ECG chart”.

I guess the surgeon would be laughing at me if I suggested keeping them both and putting a needle in each as they share equal flow, one for arterial the other for venous, because I’m anatomically illiterate, he may think my idea mad. It makes sense in layman’s logic, it will separate arterial flow from venous flow so to prevent back flow and prolong the life of the fistula. I may try my thought on the surgeon.

My surgeon is a young energetic registrar who is nice, kind, looks intelligent and capable who did my catheter operation as well; however, nurses didn’t like my catheter when they changed dressings for its awkward position, yet they didn’t voice their trouble to the surgeon who kelp on churning out patients with similarly positioned catheter.

The fistula he created for me in October has a few issues hence next week’s surgery. One of which was as I stated earlier there was a branch which siphoned off half of the blood, and another issue was the anastomosis at 2.1mm in diameter was quite narrow, and just above which was even narrower at 1.4mm, the outflow is 199mils p/minute, 11cm above wrist crease the vein is 6.8mm and my artery at fistula is 3.5mm, the fistula inflow volume is 488p/m. Due to these issues the fistula is useless. The correction of the problem is to do a turndown which I have no idea what it means exactly, apart from knowing that the artery and venous connecting point is too narrow providing limited blood flow and need to be widened to be useful for dialysis.

           [The ultra sound was done 16 Dec 2013, since then the branch on the right has grown, flows to both are close to equal, a little over 200ml/min on the left, and about 200ml/min on the right, by my last ultra sound check 5th Feb 2014. Now I feel, it is about the same. ]

The funny side of the story is the initial fistula was scheduled as urgent which was operated on 31 Oct 13 after the veins were mapped on 26 Sep 2013; the repair job labelled as semi urgent before Christmas is scheduled for 18 March. The optimal usage time for a catheter is 6 months, mine was done 10^th Sep 2013, I’m now is chasing the tail of luck.