Arterio-venous fistula—expanding role for venous access in mastocytosis patients

Long-term central venous access is increasingly common as there are growing number of patients suffering from conditions that require repeated infusions for various indications. However, central venous access has its downside where there is a risk of infection and thrombosis (F Pinelli, E Cecero, D Del’Innocenti, V Selmi, R Giua, G Villa et al., ‘Infection of totally implantable venous access devices: a review of literature,’ J Vasc Access 2018;19: 230–42.). Arterio-venous (AV) fistula is traditionally used for haemodialysis, however in patients requiring repeated access or long-term central venous access it can be considered as an unconventional solution. We report a case where 61-year-old male who has a history of systemic mastocytosis. He presents frequently to the Emergency Department with anaphylactic reaction requiring intravenous adrenaline, antihistamine and steroids. He had multiple issues with central lines as well as ports including line sepsis and thrombosis. On further discussion, an arterio-venous fistula was considered and surgically created to allow the AV fistula to be cannulated directly or under ultrasound guidance with its advantage it can be accessed rapidly in emergency setting.