Axillary artery to contralateral axillary vein graft fistula in chronic hemodialysis patients.
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.


OBJECTIVE
The purpose of this study is to review the clinical outcome of axillary artery to contralateral axillary vein AVF as a hemodialysis vascular access.


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.


CONCLUSIONS
We conclude that axillary artery to contralateral axillary vein graft fistula may be a feasible alternative choice for chronic hemodialysis access.
Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Feng-Rong
FR
Chuang
Ming-Jang
MJ
Hsieh
Chih-Hsiung
CH
Lee
Jin-Bor
JB
Chen
Yuan-Fu
YF
Cheng
Kuo-Tai
KT
Hsu
Bor-Yau
BY
Yang
Mai-Szu
MS
Wu
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001366:Axillary Artery; D001367:Axillary Vein; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome