title: Salvaging vascular access and treatment of severe limb edema: case reports on the novel use of the hemodialysis reliable outflow vascular access device.
abstract: We report two cases in which patients on chronic hemodialysis presented with morbid unilateral edema of the upper extremity and chest on the side of a currently functioning arteriovenous access. Both patients were known to the vascular surgery service and had previously undergone multiple attempts to create and maintain vascular access. Both severe and disabling edema and the need to maintain dialysis access were of significant concern. These patients were taken to the operating room to address both issues. Upper extremity venography with central venous runoff revealed central vein stenosis and/or occlusion resistant to angioplasty and stenting. Ultimately, these two patients received the Hemodialysis Reliable Outflow vascular access device. The experiences in this study demonstrate the novel use of a relatively new vascular access device for salvage of a malfunctioning arteriovenous fistula or graft as well as treatment of symptoms and complications resulting from long standing vascular access.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Gage
authors.forename: Hardeep S
authors.initials: HS
authors.lastname: Ahluwalia
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lawson
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003251:Constriction, Pathologic; D004487:Edema / Q000209:etiology / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D010690:Phlebography; D012008:Recurrence; D006435:Renal Dialysis; D016879:Salvage Therapy; D012720:Severity of Illness Index; D015607:Stents; D013536:Suture Techniques; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency