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Excellent quality of life after 31 years of parenteral nutrition via an arteriovenous fistula

European Journal of Clinical Nutrition volume 62, pages 1253–1254 (2008)Cite this article

Home parenteral nutrition (HPN) is a life-saving strategy in patients with severe intestinal failure. However, the quality of life of these patients remains to be compromised by the frequent development of technique-related complications, especially catheter infections and liver failure. We present a case that shows that not all patients suffer from these problems and that arteriovenous fistulae (AVF) can be suitable means to deliver HPN.

A female patient underwent a near-total small bowel resection at the age of 26 years because of acute intestinal ischemia, caused by a malrotation. The remaining duodenum was anastomosed to the transverse colon. Parenteral nutrition was initiated over an AVF, created on the left forearm from bovine graft material. Six months later, she acutely developed a severe septic shock after using a bag of nutrition that was contaminated by Streptococcus viridans. Her AVF occluded during this period and a second bovine graft AVF was created on the right forearm. Six years later, this AVF became occluded and a third AVF was created on the right forearm with autologous material (saphenous vein). Two central lines that were used during the maturation of her shunts had to be prematurely removed owing to catheter sepsis, caused by Staphylococcus aureus. Ever since, 25 years after the creation of the third AVF and 31 years after the initiation of HPN, there have been no major events and she is currently doing very well. She has developed minor cholestasis, with a recent liver biopsy showing discrete steatosis, fibrosis and chronic portal tract inflammation, but no cirrhosis. Intravenous warfarin (as anticoagulant because of her shunt) and alendronate (because of osteoporosis of the lumbar spine) comprise her medications at this point.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    M Versleijen, R Vissers & G Wanten

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  1. M Versleijen
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  2. R Vissers
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  3. G Wanten
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Correspondence to G Wanten.

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Versleijen, M., Vissers, R. & Wanten, G. Excellent quality of life after 31 years of parenteral nutrition via an arteriovenous fistula. Eur J Clin Nutr 62, 1253–1254 (2008). https://doi.org/10.1038/sj.ejcn.1602864

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