title: Arterioarterial prosthetic loop: a new approach for hemodialysis access.
abstract: OBJECTIVE
  In this report we present a novel procedure that uses an arterioarterial prosthetic loop (AAPL) with the proximal axillary or the femoral artery as a vascular access for hemodialysis in patients who have inadequate vascular conditions for creating an arteriovenous fistula or graft.
  
  
  METHODS
  Between April 1996 and September 2004, 34 patients received 36 AAPLs as vascular access, either as an axillary chest loop (n = 31) or as a femoral loop (n = 5). In this procedure the artery is ligated between the anastomoses to direct flow through the AAPL. Data from all patients undergoing the procedure were prospectively collected.
  
  
  RESULTS
  The indication for an AAPL was the unsuitability of large deep veins in 64%, steal syndrome in 11%, the combination of only a suitable femoral vein and severe peripheral arterial disease in 22%, and congestive heart failure in 3%. All AAPLs were cannulated 18 +/- 4 days postoperatively. Mean follow-up was 31 months (range, 1 to 83). Primary patency was 73% and secondary patency was 96% at 1 year; these rates at 3 years were 54% and 87%, respectively. The rate of all interventions for the maintenance of AAPL function was 0.47 procedures per patient year. Four grafts were abandoned. More than 11,000 hemodialyses with proven efficiency were performed.
  
  
  CONCLUSIONS
  The AAPL is an unusual but useful and easy-to-perform alternative procedure to create vascular access for hemodialysis. It can provide survival for strictly selected patients in whom conventional vascular access is not possible. The axillary chest AAPL is preferred.
authors.affiliation: Department of Vascular Surgery, Queen Elisabeth Hospital, Berlin, Germany. J.Zanow@kch-berlin.de
authors.forename: Juergen
authors.initials: J
authors.lastname: Zanow
authors.forename: Ulf
authors.initials: U
authors.lastname: Kruger
authors.forename: Michael
authors.initials: M
authors.lastname: Petzold
authors.forename: Karen
authors.initials: K
authors.lastname: Petzold
authors.forename: Helga
authors.initials: H
authors.lastname: Miller
authors.forename: Hans
authors.initials: H
authors.lastname: Scholz
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001366:Axillary Artery / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008026:Ligation; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene