Long-term results of chest wall arteriovenous graft for establishing hemodialysis access_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHE Kang ,  ZHANG Xiansheng , YIN Jie , CHENG Gong , CHEN Xiangrong

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

Corresponding author：

ZHANG Xiansheng, Email: zxs66229@sina.com

Keywords：

Arteriovenous graft; chest wall arteriovenous graft; long-term patency rate; hemodialysis

DOI：

10.7507/1002-1892.201802003

Video：

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Objective To explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease.Methods A retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity.Results All patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis.Conclusion Although the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.

Citation： SHE Kang, ZHANG Xiansheng, YIN Jie, CHENG Gong, CHEN Xiangrong. Long-term results of chest wall arteriovenous graft for establishing hemodialysis access. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 227-231. doi: 10.7507/1002-1892.201802003 Copy

1.	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.
2.	Gale-Grant O, Chemla ES. Single-center results of a series of prosthetic axillary-axillary arteriovenous access grafts for hemodialysis. J Vasc Surg, 2016, 64(6): 1741-1746.
3.	Dracon M, Watine O, Pruvot F, et al. Axillo-axillary access in hemodialysis. Nephrologie, 1994, 15(2): 175-176.
4.	Morsy MA, Khan A, Chemla ES. Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: a prospective single-center experience. J Vasc Surg, 2008, 48(5): 1251-1254.
5.	成功, 张宪生, 尹杰, 等. 胸壁与上肢人工血管透析通路的通畅率及影响因素比较. 中国微创外科杂志, 2016, 16(4): 289-293.
6.	尹杰, 佘康, 张宪生, 等. 胸壁人工血管透析通路的中期疗效报道. 中国修复重建外科杂志, 2015, 29(9): 1129-1132.
7.	Price AJ, Fidelman N, Wilson MW, et al. Percutaneous interventions in failing " necklace” hemodialysis grafts: long-term outcomes. J Vasc Interv Radiol, 2014, 25(2): 199-205.
8.	Hunter JP, Nicholson ML. Midterm experience of ipsilateral axillary-axillary arteriovenous loop graft as tertiary access for haemodialysis. J Transplant, 2014, 2014: 908738.
9.	Mohamed IH, Bagul A, Doughman T, et al. Axillary-axillary loop graft for hemodialysis access. J Vasc Access, 2011, 12(3): 262-263.
10.	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.
11.	McCann RL. Axillary grafts for difficult hemodialysis access. J Vasc Surg, 1996, 24(3): 457-461.
12.	Otani M, Takeo M, Nakajima Y. Anterior chest wall arteriovenous graft for dialysis. J Vasc Access, 2013, 14(2): 207.
13.	Jean-Baptiste E, Hassen-Khodja R, Haudebourg P, et al. Axillary loop grafts for hemodialysis access: midterm results from a single-center study. J Vasc Surg, 2008, 47(1): 138-143.
14.	Frampton AE, Hossain M, Hamidian Jahromi A, et al. Rescue of an axillary-axillary arteriovenous graft not amenable to endovascular intervention by formation of an axillary loop: a case report. J Vasc Access, 2009, 10(1): 55-58.
15.	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.
16.	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.
17.	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.
18.	Shenoy S, Miller A, Petersen F, et al. A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique. J Vasc Surg, 2003, 38(2): 229-235.
19.	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.

1. 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.
2. Gale-Grant O, Chemla ES. Single-center results of a series of prosthetic axillary-axillary arteriovenous access grafts for hemodialysis. J Vasc Surg, 2016, 64(6): 1741-1746.
3. Dracon M, Watine O, Pruvot F, et al. Axillo-axillary access in hemodialysis. Nephrologie, 1994, 15(2): 175-176.
4. Morsy MA, Khan A, Chemla ES. Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: a prospective single-center experience. J Vasc Surg, 2008, 48(5): 1251-1254.
5. 成功, 张宪生, 尹杰, 等. 胸壁与上肢人工血管透析通路的通畅率及影响因素比较. 中国微创外科杂志, 2016, 16(4): 289-293.
6. 尹杰, 佘康, 张宪生, 等. 胸壁人工血管透析通路的中期疗效报道. 中国修复重建外科杂志, 2015, 29(9): 1129-1132.
7. Price AJ, Fidelman N, Wilson MW, et al. Percutaneous interventions in failing " necklace” hemodialysis grafts: long-term outcomes. J Vasc Interv Radiol, 2014, 25(2): 199-205.
8. Hunter JP, Nicholson ML. Midterm experience of ipsilateral axillary-axillary arteriovenous loop graft as tertiary access for haemodialysis. J Transplant, 2014, 2014: 908738.
9. Mohamed IH, Bagul A, Doughman T, et al. Axillary-axillary loop graft for hemodialysis access. J Vasc Access, 2011, 12(3): 262-263.
10. 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.
11. McCann RL. Axillary grafts for difficult hemodialysis access. J Vasc Surg, 1996, 24(3): 457-461.
12. Otani M, Takeo M, Nakajima Y. Anterior chest wall arteriovenous graft for dialysis. J Vasc Access, 2013, 14(2): 207.
13. Jean-Baptiste E, Hassen-Khodja R, Haudebourg P, et al. Axillary loop grafts for hemodialysis access: midterm results from a single-center study. J Vasc Surg, 2008, 47(1): 138-143.
14. Frampton AE, Hossain M, Hamidian Jahromi A, et al. Rescue of an axillary-axillary arteriovenous graft not amenable to endovascular intervention by formation of an axillary loop: a case report. J Vasc Access, 2009, 10(1): 55-58.
15. 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.
16. 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.
17. 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.
18. Shenoy S, Miller A, Petersen F, et al. A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique. J Vasc Surg, 2003, 38(2): 229-235.
19. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Long-term results of chest wall arteriovenous graft for establishing hemodialysis access

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