|
|
 |
Back to Annual Meeting Symposium
Axillary-Axillary Arteriovenous PTFE Grafts for Hemodialysis in Difficult Patients
Joseph Liechty, MD, Brad Grimsley, MD, Greg Pearl, MD, Bertram Smith, MD, Dennis Gable, MD, Stephen Hohmann, MD, Taylor Hicks, MD, John Kedora, MD, Toby Dunn, MD, Tammy Fischer, RN, Wes Oglesby, BS, Wilson Davis, MD, William Shutze, MD.
Baylor University Medical Center, Dallas, TX, USA.
Objectives: Long-term hemodialysis patients are a difficult patient population as they have few remaining access options and may have disadvantaged vasculature in the upper extremities. Because of the increased infection rate with femoral access, surgeons may place an axillary artery to axillary vein arteriovenous graft (AAAVg). Few outcome reports of this technique exist. In this study, which is the largest reported to date, we investigate the results of the AAAVg configuration.
Methods: At our institution an AAAVg is a PTFE graft in a loop configuration in the upper chest with anastomoses to the axillary artery and ipsilateral axillary vein. After IRB approval was obtained, patients were retrospectively and then prospectively identified and followed for a two year period.
Results: Sixty-three AAAVgs were reviewed. The patient’s average age was 55 years (range 23-85). Ninety-three percent had documented prior access. Thirty-eight patients required graft interventions in the follow-up period. Twenty-one balloon angioplasties were performed for outflow venous stenosis. 14 grafts thrombosed at an average of 461 days after implant; 7 patients had bacteremia resulting in 4 graft removals as the infective source (6%). Two wound complications (1 hematoma, 1 superficial wound dehiscence) occurred but the graft was preserved. Notably, no patient required treatment for steal. The average primary patency rate was 85% at 30 days, 51% at 6 months and 33% at 1 year. Primary assisted patency was 90% at 6 months, 79% at 1 year, and 37% at 2 years. Secondary patency was 92% at 6 months and 58% at 1 year. Twenty-one patients required a new access at an average of 477 days following initial placement. Twenty-five of the 63 patients have died since receiving their grafts and one patient was transplanted.
Conclusions: Axillary AV grafts are appropriate for patients who have few upper extremity access options. The patency rates for this “bailout” procedure are at least equivalent to other upper extremity AV grafts. The lack of symptomatic steal is an important benefit. The infection rate is lower than femoral grafts and correspondingly, AAAVgs can even be considered for primary use in patients that have disadvantaged upper extremity vasculature or who are at increased risk of steal syndrome.
Back to Annual Meeting Symposium
|
