title: Early Results of Brachial Arterio-Arterial Prosthetic Loop (AAPL) for Hemodialysis.
abstract: BACKGROUND
  Vascular access has always been the Achilles heel of hemodialysis. Advances in health care have brought forward patients requiring treatment who have no veins suitable for creation of arteriovenous fistula (AVF) or insertion of central venous catheters. Use of an artery as permanent vascular access has been reported by many authors. This study reports brachial AAPL as an efficient and safe access for hemodialysis patients with central venous occlusion.
  
  
  METHODS
  Between January 2011 and December 2014, 35 brachial arterio-arterial prosthetic loops (AAPL) were created. The age of patients ranged between 27 and 72 years, with a mean age of 52.8 years.
  
  
  RESULTS
  The primary patency rates were 87.9%, 70.4%, and 38.8% at 12, 24, and 36 months, respectively. The secondary patency was 90.7%, 80.3%, and 67.6% at 12, 24, and 36 months, respectively, after successful thrombectomy in seven cases.
  
  
  CONCLUSIONS
  Mid-term follow-up results demonstrate patency rates comparable with those of the synthetic AVF. The rate of complications, although slightly higher than that with traditional synthetic AVF, is still acceptable in this population with no option for access.
authors.affiliation: Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: T
authors.initials: T
authors.lastname: Khafagy
authors.affiliation: Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: S
authors.initials: S
authors.lastname: Regal
authors.affiliation: Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital Galway (UCHG), Newcastle Road, Galway, Ireland. Electronic address: dr-m7md@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: ElKassaby
authors.affiliation: Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: E
authors.initials: E
authors.lastname: Saad
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D014654:Vascular Patency / Q000502:physiology
keywords: Alternative dialysis access; Arterio-arterial loop; Brachial arterio-arterial loop; Hemodialysis access; Unusual dialysis access; Vascular access