Unforeseen complications of delayed vascular access intervention: A case report in the wake of the COVID-19 pandemic

Introduction: Well-functioning dialysis access is of utmost importance as the lifeline of those with end stage kidney disease (ESKD) With the evolvement of COVID-19 pandemic, elective procedures were placed on hold The American Society of Diagnostic and Interventional Nephrology (ASDIN) and Vascular Access Society of the Americas (VASA) issued a joint position statement on March 24, 2020, designating dialysis vascular access procedures to be 'essential' We present a case with a series of complications that could have been prevented had the patient undergone a timely thrombectomy procedure Case Description: A 62 year old woman with ESKD undergoing hemodialysis through an upper arm arteriovenous fistula (AVF) presented with a thrombosed AVF in early March 2020 (before the ASDIN statement was issued) She was evaluated by the surgical team;however, due to restrictions to surgical procedures at the time, she did not undergo a thrombectomy and had a right internal jugular tunneled dialysis catheter (TDC) inserted instead This was complicated by a superior vena cava thrombosis a few weeks later The TDC was then removed and she had a right femoral TDC placed She was started on anticoagulation Her right femoral TDC was complicated by tunnel infection, necessitating its removal and subsequent placement of a left femoral TDC Discussion: This case illustrates the complexity of dialysis vascular access and some of the potential complications that are associated with it It also highlights the importance of timely action to rescue any failed access As outlined by the statement of ASDIN and VASA, dialysis vascular access should always be treated as a priority, and procedures to salvage it ought to be considered essential This should also be the case in any future unforeseen restrictions to surgical procedures, such as pandemics or natural disasters