Ankle arteriovenous fistula - a rare site of choice for hemodialysis

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Native arteriovenous fistula (AVF) is the ideal vascular access for hemodialysis. Once upper extremity vessels are exhausted or not suitable for AVF creation, the remaining options were either arteriovenous graft (AVG) or lower limb arteriovenous fistula.


A 45-year-old male patient with chronic kidney disease (CKD) stage V was initiated on hemodialysis through a central venous catheter. He was referred for AVF creation after failed left radiocephalic AVF. In view of poor caliber of upper limb veins and unaffordability of AVG, a lower limb AVF was considered. The patient underwent left lower limb AVF creation between the great saphenous vein and the posterior tibial artery at the ankle and perforator ligation of leg. AVF was cannulated after 6 weeks with achieved blood flow rate of 300 mL/min during dialysis. He had been continuing hemodialysis through lower limb AVF for almost 12 months at the last follow-up.


Ankle AVF could be a viable alternative to the other sites of AVF for CKD in patients where upper limb AVF is not possible. This could be an alternative in resource-limited settings; however, its long-term patency and complications will need to be assessed in large studies.

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