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An arterioarterial prosthetic graft as an alternative option for haemodialysis access: a systematic review. J Vasc Access 2018; 19:45-51. [DOI: 10.5301/jva.5000808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: All arteriovenous fistula/grafts options should be exhausted before haemodialysis is carried out via central venous catheters (CVC). CVCs carry high morbidity and mortality risks and in some patients, the central veins could be exhausted. In these patients, an arterioarterial prosthetic loop (AAPL) or straight graft can be the only option for haemodialysis. A systematic review was thus carried out to look at the use of arterioarterial graft for haemodialysis, with regards to dialysis adequacy, complications, and patency rates. Methods: An electronic search was performed using the EMBASE and MEDLINE databases from inception until June 2017. Study retrieval was conducted according to PRISMA guidelines. Results: A total of eight studies published between 1976 and 2017 were identified for pooled analysis. The studies were retrospective cohort in design and reported data on 151 patients. Primary patency rate ranged from 67%-94.5% at six months to 54%-61% at 36 months, with secondary patency rates from 83%-93% at six months to 72%-87% at 36 months. All studies documented satisfactory haemodialysis. Although limited by the size of the cohort of patients studied, patients with end-to-side grafts did not suffer from distal ischaemia when the graft occluded unlike patients who had their graft sutured as end-to-end. Conclusions: This review highlights the potential benefit of arterioarterial grafts for dialysis as an alternative vascular access option. As a result, this review calls for registry-based multicentre study to evaluate this treatment arm as an alternative option when all AVF/AVG options are exhausted.
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Hinojosa CA, Anaya-Ayala JE, Lopez-Mendez A, Gomez-Arcive Z, Laparra-Escareno H, Cuen-Ojeda C, Lizola R, Torres-Machorro A. Axillo-iliac arteriovenous hemodialysis graft creation with an early cannulation device. J Artif Organs 2016; 20:57-61. [PMID: 27709306 DOI: 10.1007/s10047-016-0927-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/27/2016] [Indexed: 11/26/2022]
Abstract
Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins. Inflow from the axillary artery and outflow in iliocaval system was assessed prior to access creation. An axillary-to-common iliac AVG was constructed using a 6 mm (mm) EC graft and tunneled in the chest and abdominal wall. Eight grafts were implanted; all were patent after placement. Seven (88 %) were successfully used for hemodialysis within 72 h and one (12 %) within 96. During the mean follow-up of 6 months, 5 (62 %) patients underwent thrombectomy, 1 (12 %) of them had balloon angioplasty at the vein anastomosis, and 2 (25 %) grafts were removed secondary to infection. The remaining grafts are still functioning. Complications as high-output heart failure, steal syndrome and venous hypertension were not observed. Construction of axillo-iliac AVG with EC grafts in the setting of exhausted veins, occluded intrathoracic central veins and hostile groins, is a viable arteriovenous access alternative while avoiding central venous catheters.
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Affiliation(s)
- Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
| | - Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
| | - Alejandra Lopez-Mendez
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
| | - Zeniff Gomez-Arcive
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
| | - Cesar Cuen-Ojeda
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
| | - Rene Lizola
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
| | - Adriana Torres-Machorro
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico
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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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Khan AR, Blackwell LM, Stafford SJ, Thompson AD, Romero RJ, Goodier CD, Kwan D, Khan IR, Schellack JV, Perkowski PE. Femororenal Arteriovenous Graft: A Viable Option for Hemodialysis Access. Ann Vasc Surg 2008; 22:136-9. [DOI: 10.1016/j.avsg.2007.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 06/27/2007] [Accepted: 07/16/2007] [Indexed: 11/17/2022]
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