Strategies to Mitigate Bleeding in Shoulder Arthroplasty in the Setting of an Arteriovenous Fistula: A Report of 3 Cases

Arteriovenous (AV) fistula in the ipsilateral extremity for hemodialysis presents unique challenges during shoulder arthroplasty. We describe 3 cases of shoulder arthroplasty performed through a deltopectoral approach on the ipsilateral side of an AV fistula. In all cases, the cephalic vein was foun...

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Bibliographic Details
Published inJBJS case connector Vol. 14; no. 1
Main Authors Seidl, Adam J, Ahmed, Abdulaziz F, Woods, David, Abboud, Joseph A, Bravman, Jonathan T
Format Journal Article
LanguageEnglish
Published United States 01.01.2024
Subjects
Arteriovenous Fistula
Arthroplasty, Replacement, Shoulder
Axillary Vein
Humans
Renal Dialysis
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Summary:Arteriovenous (AV) fistula in the ipsilateral extremity for hemodialysis presents unique challenges during shoulder arthroplasty. We describe 3 cases of shoulder arthroplasty performed through a deltopectoral approach on the ipsilateral side of an AV fistula. In all cases, the cephalic vein was found to be arterialized with increased diameter and thickness. All procedures were successfully performed without injury to the arterialized cephalic vein. This report highlighted strategies to mitigate catastrophic bleeding from an arterialized cephalic vein during shoulder arthroplasty, which includes preoperative cross-matching, expeditious vascular surgery availability, meticulous surgical dissection, and careful retractor placement.
ISSN:2160-3251
DOI:10.2106/JBJS.CC.23.00585