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Shimasaki M, Rachi H, Shiratori K, Takanohashi S, Uyama S, Yamada K, Totsuka Y, Takanohasi A, Shirota K, Nakamura H, Togawa A. Long-term outcomes of anterior chest wall arteriovenous graft with polyurethane. J Vasc Access 2021; 23:930-935. [PMID: 34000892 DOI: 10.1177/11297298211012205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anterior chest wall arteriovenous graft (ACWAVG) is one option for haemodialysis patients when vessels of the upper extremities become exhausted. We report here the long-term outcomes of ACWAVG with polyurethane. METHODS From April 2005 to October 2015, nine ACWAVGs with polyurethane grafts were created. We observed patients until April 2019 and evaluated graft patency, interval from operation to first cannulation, and numbers of interventions and complications. RESULTS Primary patency rate and secondary patency rate of 6, 12 and 24 months were 55.3%, 33.3%, 33.3% and 77.8%, 55.6%, 55.6% respectively. Mean interval from operation to first cannulation was 3 days. Infection rate and kinking formation rate were slightly higher than previous reports of ACWAVGs with expanded polytetrafluoroethylene (ePTFE). However, one patient was able to keep using a single graft for 166 months with multiple interventions. CONCLUSIONS Slight disadvantage are seen with patency rate and complication rate in polyurethane ACWAVG compare to ePTFE. However, when early cannulation is required, polyurethane is worth to consider for creating ACWAVG.
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Affiliation(s)
- Megumi Shimasaki
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan.,Department of Nephrology, Yaizu City Hospital, Yaizu, Shizuoka, Japan
| | - Hiromu Rachi
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Kimitoshi Shiratori
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Seiko Takanohashi
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Satoko Uyama
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Kei Yamada
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Yuichi Totsuka
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Akira Takanohasi
- Department of Thoracic Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Kazuaki Shirota
- Department of Thoracic Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Hajime Nakamura
- Department of Thoracic Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
| | - Akashi Togawa
- Department of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka city, Japan
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Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JH, van Loon M, ESVS Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, ESVS Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:757-818. [DOI: 10.1016/j.ejvs.2018.02.001] [Citation(s) in RCA: 346] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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3
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Gale-Grant O, Chemla ES. Single-center results of a series of prosthetic axillary-axillary arteriovenous access grafts for hemodialysis. J Vasc Surg 2016; 64:1741-1746. [DOI: 10.1016/j.jvs.2016.07.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 07/17/2016] [Indexed: 10/20/2022]
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4
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MacRae JM, Dipchand C, Oliver M, Moist L, Yilmaz S, Lok C, Leung K, Clark E, Hiremath S, Kappel J, Kiaii M, Luscombe R, Miller LM. Arteriovenous Access: Infection, Neuropathy, and Other Complications. Can J Kidney Health Dis 2016; 3:2054358116669127. [PMID: 28270919 PMCID: PMC5332082 DOI: 10.1177/2054358116669127] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022] Open
Abstract
Complications of vascular access lead to morbidity and may reduce quality of life. In this module, we review both infectious and noninfectious arteriovenous access complications including neuropathy, aneurysm, and high-output access. For the challenging patients who have developed many complications and are now nearing their last vascular access, we highlight some potentially novel approaches.
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Affiliation(s)
- Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Serdar Yilmaz
- Department of Surgery, University of Calgary, Alberta, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Kelvin Leung
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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5
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Unusual sites for hemodialysis vascular access construction and catheter placement: A review. Int J Artif Organs 2015; 38:293-303. [PMID: 26242845 DOI: 10.5301/ijao.5000416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/20/2022]
Abstract
As more end-stage renal disease patients require hemodialysis and live longer, many will fail to develop or maintain a functioning upper extremity vascular access. When a patient exhausts vascular access sites in the upper extremities, new fistulas and grafts can be constructed in the lower extremities, thorax, and abdomen as long as a pair of proximate artery and vein provide adequate blood inflow and outflow, respectively. When only a moderate size vein with adequate blood flow provides a conduit to either a patent superior or inferior vena cava, inserting a double-lumen venous hemodialysis catheter can provide temporary or permanent access. We review the literature and report the unusual sites for hemodialysis vascular access and catheter placement.
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6
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Abstract
The most complex patients requiring vascular access are those with bilateral central vein occlusions. Endovascular repair of the central lesions when feasible allow upper extremity use for access. When endovascular repair is not feasible, femoral vein transposition should be the next choice. When lower limb access sites have been exhausted or are contraindicated as in obese patients and in patients with peripheral arterial obstructive disease, a range of extrathoracic "exotic" extra-anatomic access procedures as the necklace cross-chest arteriovenous (AV) grafts, the ipsilateral axillo-axillary loops, the brachial-jugular AV grafts, the axillo-femoral AV grafts or even intra-thoracic ones as the right atrial AV bypasses represent the vascular surgeon's last resort. The selection among those extra-anatomical chest-wall procedures should be based upon each patient's anatomy or patient-specific factors.
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7
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Price AJ, Fidelman N, Wilson MW, Kerlan RK. Percutaneous interventions in failing "necklace" hemodialysis grafts: long-term outcomes. J Vasc Interv Radiol 2013; 25:199-205. [PMID: 24290096 DOI: 10.1016/j.jvir.2013.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine primary and secondary patency after percutaneous interventions for malfunctioning anterior chest wall ("necklace") arteriovenous grafts (AVGs) for hemodialysis. MATERIALS AND METHODS Records of six consecutive patients with subclavian artery-to-contralateral subclavian vein necklace AVGs were reviewed. Patients underwent 34 procedures, including 28 balloon angioplasties, 24 pharmacomechanical thrombolyses, and six stent placements. Patency intervals after graft placement and after first intervention were calculated. RESULTS After 3 months, primary and secondary patency rates were 33% (two of six grafts) and 67% (four of six grafts), respectively. At 12 months, primary and secondary patency rates were 17% (one of six grafts) and 50% (three of six grafts), respectively. Median and mean primary patency times were 49 and 374 days, and median and mean secondary patency times were 293 and 575 days, respectively. The anatomic success rate of percutaneous interventions in malfunctioning AVGs was 97% (33 of 34 cases). At 3 years after implantation, the graft patency rate was 57% (four of seven grafts). CONCLUSIONS Percutaneous interventions were effective at maintaining patency in failing necklace AVGs. However, their primary and secondary patency were inferior to those cited in extremity AVG guidelines set forth by the Society of Interventional Radiology.
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Affiliation(s)
- Adi J Price
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143
| | - Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143.
| | - Mark W Wilson
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143
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9
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Park BJ, Kim HR, Chung HH, Sung DJ, Park SJ, Son HS, Jo SK, Kim YH, Cho SB. Percutaneous intervention in axillary loop-configured arteriovenous grafts for chronic hemodialysis patients. Korean J Radiol 2010; 11:195-202. [PMID: 20191067 PMCID: PMC2827783 DOI: 10.3348/kjr.2010.11.2.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 11/03/2009] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. Materials and Methods Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. Results Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. Conclusion Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.
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Affiliation(s)
- Beom Jin Park
- Department of Radiology, College of Medicine, Korea University, Seoul 136-705, Korea
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10
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Chuang FR, Hsieh MJ, Lee CH, Chen JB, Cheng YF, Hsu KT, Yang BY, Wu MS. Axillary Artery to Contralateral Axillary Vein Graft Fistula in Chronic Hemodialysis Patients. Ren Fail 2009; 25:871-8. [PMID: 14575295 DOI: 10.1081/jdi-120024302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Vascular access failure is a severe and common complication for hemodialysis patients. The possible vascular access sites are limited in dialysis patients. Axillary artery to contralateral axillary vein arteriovenous fistula (AVF) is one of the possibilities. However, the clinical outcome of this procedure is still un-defined. OBJECT The purpose of this study is to review the clinical outcome of axillary artery to contralateral axillary vein AVF as a hemodialysis vascular access. PATIENTS AND METHODS We retrospectively reviewed native or graft arteriovenous fistula records for chronic hemodialysis patients at Chang Gung Memorial Hospital in Kaohsiung, Taiwan, from January 1986 to March 2001. Records were reviewed for all chronic hemodialysis patients, with more than 2000 individuals receiving more than 10,000 fistulas. Eight patients received axillary artery to contralateral axillary vein AVF. RESULTS The mean age for these patients was 61.7 +/- 16.3 year-old at time of surgery. All patients had received multiple native or graft arteriovenous fistula creation. The 2-year and 4-year AVF graft survival is 87.5% and 43.8% respectively. One patients developed brachial plexopathy after operation. Another patient had venous hypertension distal to the AVF site. Both patients were managed conservatively. There is no AVF-related mortality in these patients. CONCLUSION We conclude that axillary artery to contralateral axillary vein graft fistula may be a feasible alternative choice for chronic hemodialysis access.
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Affiliation(s)
- Feng-Rong Chuang
- Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Hollenbeck M, Mickley V, Brunkwall J, Daum H, Haage P, Ranft J, Schindler R, Thon P, Vorwerk D. Gefäßzugang zur Hämodialyse. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11560-009-0281-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: A prospective single-center experience. J Vasc Surg 2008; 48:1251-4, 1254.e1. [PMID: 18771891 DOI: 10.1016/j.jvs.2008.06.064] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 06/30/2008] [Accepted: 06/30/2008] [Indexed: 11/24/2022]
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13
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Niyyar VD. Anterior Chest Wall Arteriovenous Grafts: An Underutilized Form of Hemodialysis Access. Semin Dial 2008; 21:578-80. [DOI: 10.1111/j.1525-139x.2008.00491.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Fidelman N, Allen D, Bloom AI, LaBerge JM, Hastings GS, Kerlan RK, Gordon RL, Wilson MW. Percutaneous Interventions in Subclavian Artery–to–Contralateral Subclavian Vein “Necklace” Hemodialysis Grafts: Experience in Five Patients. J Vasc Interv Radiol 2007; 18:597-601. [PMID: 17494840 DOI: 10.1016/j.jvir.2007.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To describe clinical outcomes of endovascular interventions in the setting of thrombosis or dysfunction of anterior chest wall ("necklace") arteriovenous (AV) hemodialysis grafts. MATERIALS AND METHODS Eight percutaneous interventions (balloon angioplasty, pharmacologic thrombolysis, and mechanical thrombectomy) were performed in five patients with anterior chest wall AV grafts. Primary, assisted, and secondary patencies, as well as technical success and complication rates, were determined. RESULTS The technical success rate of percutaneous interventions in re-establishing a normal blood flow pattern within the AV grafts was 100%. Primary patency ranged from one to 23 months (median, 5 months). Primary assisted patency and secondary patency were 36 months and 8 months, respectively, in two patients who underwent more than one intervention. Postintervention access patency ranged from 5 to 36 months (median, 9 months), whereas graft lifetime ranged from 12 to 45 months (median, 24 months). There were no complications related to revascularization procedures. CONCLUSION Percutaneous interventions can be performed safely and effectively in anterior chest wall AV grafts. Technical success and long-term patency rates appear to be similar to those of percutaneous interventions in upper-extremity hemodialysis AV grafts.
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Affiliation(s)
- Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Rm M-361, San Francisco, CA 94143, USA
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Scott JD, Cull DL, Kalbaugh CA, Carsten CG, Blackhurst D, Taylor SM, Snyder BA, York JW, Langan EM. The mid-thigh loop arteriovenous graft: patient selection, technique, and results. Am Surg 2006; 72:825-8. [PMID: 16986394 DOI: 10.1177/000313480607200912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As patient longevity on hemodialysis has increased, surgeons are increasingly challenged to provide vascular access to patients who have exhausted options for access in the upper extremity. A common operation performed on these patients has been the loop thigh arteriovenous (AV) graft based off the common femoral vessels. However, there are several disadvantages of placing prosthetic grafts in proximity to the groin. Our group has modified the thigh loop AV graft procedure by moving the anastomoses to the mid-superficial femoral artery and vein. The advantage of this location is that it preserves the proximal femoral vessels for graft revision and avoids the node-bearing tissue and overhanging panniculus of the groin. The purpose of this study was to review our technique, patient selection, and experience with the mid-thigh loop AV graft procedure. Between 2001 and 2003, 46 mid-thigh loop AV grafts were placed in 38 patients. Patient hospital, office, and dialysis clinic records were reviewed. The primary and secondary patency for AV grafts in this study by life-table was 40 per cent and 68 per cent at 1 year and 18 per cent and 43 per cent at 2 years. There were 10 infections (21%) requiring graft removal. Four patients underwent subsequent placement of a proximal loop thigh AV graft after mid-thigh graft failure. Patient survival was 86 per cent at 1 year and 82 per cent at 2 years. There were no patient deaths related to thigh graft placement. Our results with the mid-thigh loop AV graft compare favorably with published results for thigh loop AV grafts. The procedure preserves the proximal vasculature, permitting graft revision or subsequent proximal graft placement, and may be associated with fewer infectious complications. The mid-thigh loop AV graft procedure should be considered before placement of a thigh loop AV graft based off the common femoral artery and vein.
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Affiliation(s)
- John D Scott
- Department of Academic Surgery, Greenville Hospital System University Medical Center, South Carolina, USA
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16
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Chemla ES, Morsy M, Anderson L, Makanjuola D. Asdin Original Investigation: Complex Bypasses and Fistulas for Difficult Hemodialysis Access: A Prospective, Single-Center Experience. Semin Dial 2006; 19:246-50. [PMID: 16689977 DOI: 10.1111/j.1525-139x.2006.00162.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this article is to describe several complex vascular access procedures and the outcomes achieved with them in 24 patients (mean age 60 years) undergoing hemodialysis in whom all other accesses had failed and neither peritoneal dialysis nor transplantation was possible. Patients underwent either a necklace bypass (n = 5), axillary loop (n = 1), contralateral internal jugular vein bypass (n = 6), femorofemoral crossover bypass (n = 1), superficial femoral vein transposition (n = 5), axillary artery to popliteal vein bypass (n = 5), or femoral artery to right atrium bypass (n = 1). All grafts implanted were 6 mm, internally reinforced prostheses made of expanded polytetrafluoroethylene (Gore-Tex Intering Vascular Graft). Postoperatively patients had bimonthly clinical examinations in which the thrill, bruit, skin, cannulation sites, and adequacy of dialysis were reviewed. A bimonthly ultrasound dilution assessment that included estimation of the graft inflow rate, recirculation rate, and cardiac output was also performed. There was one serious postoperative complication: rapid-onset severe steal syndrome that required immediate tie off of the fistula. During the median follow-up time of 22 months, three patients died of causes unrelated to their vascular access. Nineteen dilatations and 10 surgical revisions were done. Primary patency rates were 83%, 63.5%, and 63.5%, respectively, at 6 months, 1 year, and 2 years; secondary patency rates were 91%, 77%, and 77%. Complex vascular access procedures can provide patients some additional good-quality time on hemodialysis.
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Affiliation(s)
- Eric S Chemla
- South West London, Surrey and Sussex Renal Transplant Network, London, UK.
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Hazinedaroğlu S, Karakayali F, Tüzüner A, Ayli D, Demirer S, Duman N, Yerdel MA. Exotic arteriovenous fistulas for hemodialysis. Transplant Proc 2004; 36:59-64. [PMID: 15013301 DOI: 10.1016/j.transproceed.2003.11.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The rate of patients with exhausted upper extremity arteriovenous fistula (AVF) sites who have lost all chances for a conventional upper extremity AVF has been increasing in line with the general increase in the hemodialysis patient population. In this prospective study, we report the early and late follow-up results of "exotic" AVFs in which central veins are used for the outflow. Patients having no chance for an upper extremity AVF based on previous catheterization, surgical AVF history, detailed physical examination, and radiological assessment, were included in the study. Between June 1999 and January 2003, 27 central AVFs were created with a 6 mm synthetic vascular graft in 26 patients. The inflow artery was the proximal axillary artery in all except one. All but one operation was done by the same surgeon. The outflow vein was the internal jugular vein in 16 and infraclavicular axillary vein in 11 cases. One-year primary and secondary graft patency rates were 33.33 +/- 10.49 and 57.06 +/- 11.29, respectively. The early complications were facial edema and hemiparesis, both of which resolved spontaneously. The only late complication, pseudoaneursym, was treated by a graft interposition. In selected patients who have no suitable upper extremity vessels for an AVF, the central veins may be used with an acceptable success rate. Another advantage of this procedure is the avoidance of undesired femoral interventions; sometimes it may be the only opportunity and lifesaving for the patient.
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Affiliation(s)
- S Hazinedaroğlu
- Department of Nephrology, Ankara University Medical School, Ankara, Turkey
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