MYCOTIC PSEUDOANEURYSM OF THE RADIAL ARTERY FOLLOWING EXPLANT OF INFECTED RADIOCEPHALIC FISTULA swechhabhatt48@gmail.com

PE066

MYCOTIC PSEUDOANEURYSM OF THE RADIAL ARTERY FOLLOWING EXPLANT OF INFECTED RADIOCEPHALIC FISTULA

6

Nepal

Oral or Poster

Since 2016, Nepal’s Ministry of Health and Population has provided free hemodialysis, increasing demand for vascular access creation and maintenance. Limited vascular surgery workforce, logistical constraints, and limited training among dialysis staff may contribute to delayed recognition and treatment of arteriovenous (AV) fistula infections. We present a case of radiocephalic AV fistula infection complicated by mycotic pseudoaneurysm of the radial artery, highlighting management challenges in a resource-constrained setting.

A 33-year-old male with chronic kidney disease on hemodialysis via a two-year-old radiocephalic fistula presented with purulent drainage noted two weeks earlier. Surgical exploration revealed diffuse infection of the cephalic vein, which was excised, and the fistula ligated. Wound cultures grew MRSA, and the patient was treated with clindamycin.

Two weeks postoperatively, the patient developed a painful, pulsatile mass at the incision site. Ultrasound revealed a 2 × 3 cm pseudoaneurysm of the radial artery. Urgent re-exploration with proximal brachial control and en bloc resection of the pseudoaneurysm, including a 4 cm segment of the radial artery, was performed. The wound was packed and healed completely over four weeks with preservation of distal neurovascular function, except for mild paresthesia around the anatomic snuffbox.

Infected vascular access should be addressed promptly with complete excision of infected tissue to prevent mycotic pseudoaneurysm formation. In resource-limited environments, barriers to timely follow-up and surgical care increase the risk of advanced infection, underscoring the need for early intervention and education of dialysis staff to identify access-related complications.