Arteriovenous Hybrid Graft with Outflow in the Proximal Axillary Vein.
BACKGROUND
The patency of long-term hemodialysis access in end-stage renal disease patients remains a significant challenge. Often these patients are affected with limited venous outflow options, requiring limb abandonment, and creation of new access in the contralateral arm. Vascular surgeons are familiar with the exposure of the proximal axillary artery via an infraclavicular incision. The axillary vein is easily exposed through this technique. The use of the hybrid Gore graft can make the venous anastomosis easier. A hybrid graft with its venous outflow placed in the proximal axillary vein can extend the options of upper extremity access procedures. We reviewed our early experience with this technique.


METHODS
A review of dialysis procedures at the Loma Linda VA was performed. All patients undergoing placement of arteriovenous grafts utilizing the Gore hybrid placed into the proximal axillary vein for outflow were identified. Outcomes in terms of primary and secondary patency rates were determined.


RESULTS
Eight patients had placement of an arteriovenous hybrid graft in the proximal axillary vein via an infraclavicular incision. All patients had exhausted other options for hemodialysis access in the ipsilateral upper extremity. All grafts were used successfully for dialysis. The mean primary and secondary patency rates at 6 months were 37.5% and 62.5%, respectively. One patient developed steal syndrome, requiring proximalization of the graft. Seven out of the 8 patients required secondary procedures including thrombectomy (n = 16) and angioplasty (n = 17).


CONCLUSIONS
Placement of a hybrid graft in the proximal axillary vein is an effective and suitable option for patients who have exhausted arteriovenous access sites in the arm. This procedure can easily be performed in an outpatient setting with a low complication rate and allowing for preservation of the contralateral upper extremity for future use.
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA.
Allen G
AG
Murga
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA.
Jason
J
Chiriano
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA.
Sharon C
SC
Kiang
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA.
Sheela
S
Patel
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA.
Christian
C
Bianchi
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA.
Ahmed M
AM
Abou-Zamzam
Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, CA. Electronic address: tteruya@llu.edu.
Theodore H
TH
Teruya
D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002140:California; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011474:Prosthesis Design; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D000071062:Sutureless Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency