MID-TERM RESULTS OF ARTERIOVENOUS AXILLARY LOOP GRAFT ON CHEST FOR ESTABLISHING HEMODIALYSIS ACCESS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YINJie , SHEKang ,  ZHANGXiansheng , GUOHongjie , CHENGGong

Department of Vascular and Endovascular Surgery, Peking University First Hospital, Beijing, 100034, P. R. China;

Corresponding author：

ZHANGXiansheng, Email: zxs66229@sina.com

Keywords：

Arteriovenous graft; Arteriovenous axillary loop graft; Chest; Hemodialysis

DOI：

10.7507/1002-1892.20150245

Video：

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Objective To explore the role of arteriovenous axillary loop graft (AVALG) on chest for establishing hemodialysis access in patients with chronic renal failure. Methods A retrospective analysis was made on the clinical data of 12 patients with chronic renal failure who underwent an AVALG on chest for hemodialysis access between December 2010 and May 2014. There were 2 males and 10 females with an average age of 65.25 years (range, 46-75 years). The main causes were chronic glomerulonephritis in 6 cases, diabetic nephropathy in 4 cases, and both kidney resection because of urinary tract tumors in 2 cases. The disease duration was 2-12 years (mean, 6 years). The 12 patients all underwent 5-14 times (mean, 7 times) failed prior vascular accesses [arteriovenous fistula (AVF）and arteriovenous graft (AVG)] leading to exhaustion of venous access sites on the upper extremities. Results The AVALG on chest were functionally useful for hemodialysis access, 2-3 times per week, and the blood flow was 250-350 mL/minute; the average time for the first dialysis was 48 days (range, 42-93 days). All patients were followed up 12-54 months (mean, 20.92 months). There was no death during perioperative period. The primary patency rates at 6 and 12 months were 91.7% and 83.3% respectively, and the secondary patency rates at 6 and 12 months were both 100%. After operation, infection (1 case), thrombosis (2 cases), bleeding (2 cases), and swollen (1 case) occurred, which were all cured after corresponding treatment. Conclusion AVALG on chest is a supplementary option for chronic renal failure patients with inadequate upper extremity venous access sites after repeat occlusion.

Citation： YINJie, SHEKang, ZHANGXiansheng, GUOHongjie, CHENGGong. MID-TERM RESULTS OF ARTERIOVENOUS AXILLARY LOOP GRAFT ON CHEST FOR ESTABLISHING HEMODIALYSIS ACCESS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1129-1132. doi: 10.7507/1002-1892.20150245 Copy

1.	Hunter JP, Nicholson ML. Midterm experience of ipsilateral axillaryaxillary arteriovenous loop graft as tertiary access for haemodialysis. J Transplant, 2014, 2014:908738.
2.	Sidawy AN, Spergel LM, Besarab A, et al. The Society for Vascular Surgery:clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg, 2008, 48(5 Suppl):2S-25S.
3.	Antoniou GA, Lazarides MK, Georgiadis GS, et al. Lower-extremity arteriovenous access for haemodialysis:a systematic review. Eur J Vasc Endovasc Surg, 2009, 38(3):365-372.
4.	Mohamed IH, Bagul A, Doughman T, et al. Axillary-axillary loop graft for hemodialysis access. J Vasc Access, 2011, 12(3): 262-263.
5.	McCann RL. Axillary grafts for difficult hemodialysis access. J Vasc Surg, 1996, 24(3):457-462.
6.	Otani M, Takeo M, Nakajima Y. Anterior chest wall arteriovenous graft for dialysis. J Vasc Access, 2013, 14(2):207.
7.	Jean-Baptiste E, Hassen-Khodja R, Haudebourg P, et al. Axillary loop grafts for hemodialysis access:midterm results from a singlecenter study. J Vasc Surg, 2008, 47(1):138-143.
8.	Jiménez-Almonacid P, Gruss E, Jiménez-Toscano M, et al. Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis. Nefrologia, 2013, 33(5):692-698.
9.	Dixon BS, Beck GJ, Vazquez MA, et al. Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med, 2009, 360(21): 2191-2201.
10.	Crowther MA, Clase CM, Margetts PJ, et al. Low-intensity warfarin is ineffective for the prevention of PTFE graft failure in patients on hemodialysis:a randomized controlled trial. J Am Soc Neprol, 2002, 13(9):2331-2337.
11.	Schild AF. Maintaining vascular access:the management of hemodialysis arteriovenous grafts. J Vasc Access, 2010, 11(2):92-99.
12.	Kaufman JS, O'Connor TZ, Zhang JH, et al. Veterans affairs cooperative study group on hemodialysis access graft thrombosis. Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. J Am Soc Nephrol, 2003, 14: 2313-2321.
13.	Park BJ, Kim HR, Chung HH, et al. Percutaneous intervention in axillary loop-configured arteriovenous grafts for chronic hemodialysis patients. Korean J Radiol, 2010, 11(2):195-202.
14.	Bachleda P, Utikal P, Kocher M, et al. Arteriovenous graft for hemodialysis, graft venous anastomosis closure-current state of knowledge. Minireview. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(1):27-30.
15.	Haskal ZJ, Trerotola S, Dolmatch B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med, 2010, 362(6):494-503.

1. Hunter JP, Nicholson ML. Midterm experience of ipsilateral axillaryaxillary arteriovenous loop graft as tertiary access for haemodialysis. J Transplant, 2014, 2014:908738.
2. Sidawy AN, Spergel LM, Besarab A, et al. The Society for Vascular Surgery:clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg, 2008, 48(5 Suppl):2S-25S.
3. Antoniou GA, Lazarides MK, Georgiadis GS, et al. Lower-extremity arteriovenous access for haemodialysis:a systematic review. Eur J Vasc Endovasc Surg, 2009, 38(3):365-372.
4. Mohamed IH, Bagul A, Doughman T, et al. Axillary-axillary loop graft for hemodialysis access. J Vasc Access, 2011, 12(3): 262-263.
5. McCann RL. Axillary grafts for difficult hemodialysis access. J Vasc Surg, 1996, 24(3):457-462.
6. Otani M, Takeo M, Nakajima Y. Anterior chest wall arteriovenous graft for dialysis. J Vasc Access, 2013, 14(2):207.
7. Jean-Baptiste E, Hassen-Khodja R, Haudebourg P, et al. Axillary loop grafts for hemodialysis access:midterm results from a singlecenter study. J Vasc Surg, 2008, 47(1):138-143.
8. Jiménez-Almonacid P, Gruss E, Jiménez-Toscano M, et al. Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis. Nefrologia, 2013, 33(5):692-698.
9. Dixon BS, Beck GJ, Vazquez MA, et al. Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med, 2009, 360(21): 2191-2201.
10. Crowther MA, Clase CM, Margetts PJ, et al. Low-intensity warfarin is ineffective for the prevention of PTFE graft failure in patients on hemodialysis:a randomized controlled trial. J Am Soc Neprol, 2002, 13(9):2331-2337.
11. Schild AF. Maintaining vascular access:the management of hemodialysis arteriovenous grafts. J Vasc Access, 2010, 11(2):92-99.
12. Kaufman JS, O'Connor TZ, Zhang JH, et al. Veterans affairs cooperative study group on hemodialysis access graft thrombosis. Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. J Am Soc Nephrol, 2003, 14: 2313-2321.
13. Park BJ, Kim HR, Chung HH, et al. Percutaneous intervention in axillary loop-configured arteriovenous grafts for chronic hemodialysis patients. Korean J Radiol, 2010, 11(2):195-202.
14. Bachleda P, Utikal P, Kocher M, et al. Arteriovenous graft for hemodialysis, graft venous anastomosis closure-current state of knowledge. Minireview. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(1):27-30.
15. Haskal ZJ, Trerotola S, Dolmatch B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med, 2010, 362(6):494-503.

Chinese Journal of Reparative and Reconstructive Surgery

MID-TERM RESULTS OF ARTERIOVENOUS AXILLARY LOOP GRAFT ON CHEST FOR ESTABLISHING HEMODIALYSIS ACCESS

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