Introduction:

A 50-year-old man, with chronic renal failure secondary to IgA nephropathy who had been on CAPD for 5 years, was admitted to the renal department for antibiotic resistant peritonitis. After 1 week of empirical treatment with fluconazole the peritoneal catheter was removed and the patient was switched to haemodialysis. The patient was a heavy smoker (40 cigarettes/day) and had a family history of myocardial infarction. He had had an episode of thrombophlebitis in his right leg before starting peritoneal dialysis. He was receiving Erithropoietin (12000 UI/week) in addition to i.v. Iron. His blood pressure was well controlled with antihypertensive drugs (ACE inhibitors and Calcium channel blockers). One month after the resolution of peritonitis the patient underwent surgery to prepare a brachial AV fistula in his left arm. The AV fistula was functioning well at the end of the operation but stopped on the first post-operative day. The patient was immediately sent to the surgeon who found extensive clotting of the venous and arterial sides of the vascular access and an attempt at creating a new A-V fistula failed because of early clotting.

Question 1