The Will to Live: Preservation of a Forearm Loop Arteriovenous Graft via Development of Median Cubital Venous Collateral Circulation

Forearm loop arteriovenous grafts most commonly fail because of stenosis, with thrombosis at the venous anastomosis. Treatment begins with identification of the stenotic lesion causing thrombosis, followed by either a percutaneous method using thrombolytic agents with possible balloon angioplasty and mechanical evacuation or surgical thrombectomy. We present a case of thrombosis in a forearm loop graft with successful percutaneous thrombectomy. Preservation of this access site was only possible because of an unusual finding of collateral circulation, with the median cubital vein acting as a conduit to the basilic vein. The choice of surgical vs percutaneous methods for treating a thrombosed graft remains controversial. Yet the success rates of pharmacologic thrombolysis and the percutaneous approach are comparable to those of surgical thrombectomy. Our case of successful percutaneous thrombectomy illustrates the value of preserving the median cubital vein whenever possible in the placement of forearm arteriovenous grafts.