title: Axillo-iliac arteriovenous hemodialysis graft creation with an early cannulation device.
abstract: Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins. Inflow from the axillary artery and outflow in iliocaval system was assessed prior to access creation. An axillary-to-common iliac AVG was constructed using a 6 mm (mm) EC graft and tunneled in the chest and abdominal wall. Eight grafts were implanted; all were patent after placement. Seven (88 %) were successfully used for hemodialysis within 72 h and one (12 %) within 96. During the mean follow-up of 6 months, 5 (62 %) patients underwent thrombectomy, 1 (12 %) of them had balloon angioplasty at the vein anastomosis, and 2 (25 %) grafts were removed secondary to infection. The remaining grafts are still functioning. Complications as high-output heart failure, steal syndrome and venous hypertension were not observed. Construction of axillo-iliac AVG with EC grafts in the setting of exhausted veins, occluded intrathoracic central veins and hostile groins, is a viable arteriovenous access alternative while avoiding central venous catheters.
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico. carlos.a.hinojosa@gmail.com.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Hinojosa
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Lopez-Mendez
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Zeniff
authors.initials: Z
authors.lastname: Gomez-Arcive
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Hugo
authors.initials: H
authors.lastname: Laparra-Escareno
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Cesar
authors.initials: C
authors.lastname: Cuen-Ojeda
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Rene
authors.initials: R
authors.lastname: Lizola
authors.affiliation: Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
authors.forename: Adriana
authors.initials: A
authors.lastname: Torres-Machorro
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001807:Blood Vessel Prosthesis; D002404:Catheterization; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Axillo-iliac arteriovenous grafts; Early cannulation grafts; Technique