Axillo-iliac conduit for haemodialysis vascular access.
OBJECTIVE
To describe a series of venous surgical procedures performed to maintain vascular access.


METHODS
We report eight patients with end-stage renal failure (ESRF) who had complex renal access problems. Three patients had central venous occlusion and underwent veno-venous axillo-iliac bypass. In five further patients with a symptomatic central venous obstruction we performed axillo-iliac arterio-venous grafting (AVGs) in order to achieve haemodialysis access. All patients were assessed pre-operatively with duplex ultrasound and venogram of upper and lower limbs. The axillary artery or vein, and iliac vein were approached via infraclavicular and extra-peritoneal groin incisions, respectively. Non-externally-supported polytetrafluoroethylene (PTFE) was used as a conduit in all patients and anti-coagulation regimen were commenced post-operatively.


RESULTS
Following venous diversion surgery, there was a dramatic improvement in the facial and limb swelling experienced by the patients. There was no significant peri-operative morbidity. The veno-venous graft is still patent at 14 months in patient one, at 10 months in patient two, and 5 months in patient three. In the second group, who had arterio-venous grafts, the mean follow-up was 13.2 (7-20) months with a secondary patency rate of 80% at 6 months. Four patients had patent, usable grafts at 12 months. In two cases, graft occlusion was treated with successful thrombectomy.


CONCLUSIONS
Axillary-iliac veno-venous diversion can overcome the symptoms and complications of superior vena cava and innominate vein obstruction. Although, axillo-iliac arterio-venous graft fistulae formation was previously described it has not been widely used. We have found the procedure to have low morbidity and advocate its use in these complex cases.
Hamish
M
M
West of London Vascular Service, Charing Cross Hospital, London W6 8RF, UK. mhamish@hotmail.com
Shalhoub
J
J
Rodd
C D
CD
Davies
A H
AH
D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001366:Axillary Artery / Q000601:surgery*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D006801:Humans; D007084:Iliac Vein / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000601:surgery; D006435:Renal Dialysis