External Carotid Artery to External Jugular Vein Arteriovenous Fistulae for Hemodialysis Access

OBJECTIVE: The quest to maintain access in the chronic hemodialysis patient can sometimes be quite formidable. The purpose of this study is to report a series of 6 Cervical Arteriovenous Fistulae created as a nearly last imaginable means of creating and maintaining hemodialysis access.
METHODS: A retrospective review was conducted of patients that underwent the creation of a cervical arteriovenous fistula. A multifaceted review of the world literature was undertaken to document prior report and use of similarly constructed accesses.
RESULTS: Six External Jugular Vein to External Carotid Artery fistulae were created in 5 patients. All fistulae matured, obtained very significant volumes of flow and were accessed reliably for 4 wks to nearly two years. Three fistula remain patent and in use at this time. These findings are quite unique, especially given the lack of direct axial venous outflow to the Right Atrium, in all patients.
CONCLUSION: Based on these results, I believe the cervical fistula should be considered as a means of maintaining access for hemodialysis patients who have failed and exhausted all other attempts at upper and lower extremity access. This report appears to be the first ever documentation of the use of a cervical arteriovenous fistula with both arterial and venous needles.