Difficult vascular access for hemodialysis in congenital bilateral absence of radial artery and probable VACTERL association: a case report

Abstract

Isolated bilateral absence of radial artery in association with other congenital anomalies, together named VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) is a very rare phenomenon. We report a patient, known to have VACTERL association, and who presented with ESRD. He was on hemodialysis and had been subjected to multiple failed tries at vascular access due to congenital bilateral absence of radial arteries and other vascular anomalies. This case report highlights hemodialysis options in congenital bilateral absence of radial artery and probable VACTERL association showing superiority of arteriovenous fistula despite its accompanying complications. Key words: VACTERL; Abnormalities, Multiple / classification; Kidney / abnormalities; Limb Deformities, Congenital; Bilateral absent radial artery; Hemodialysis; AV fistula, Failure; AV fistula, Complications Abbreviations: VACTERL - Vertebral defects, Anal atresia, Cardiac defects, Tracheo-esophageal fistula, Renal anomalies, and Limb abnormalities; AVF - Arteriovenous fistula; ESRD - End-stage renal disease; AVG - Arteriovenous graft; CVC - Central venous catheter Citation: Kareem G, Mahbuba W. Difficult vascular access for hemodialysis in congenital bilateral absence of radial artery and probable VACTERL association: a case report. Anaesth. pain intensive care 2022;26(3):559-562. DOI: 10.35975/apic.v26i4.1966 Received: June 05, 2022; Reviewed: June 12, 2022; Accepted: June 17, 2022