Vascular access in hemodialysis patients can be challenging especially in those with failed primary, secondary and/or tertiary procedures. We present a technique which utilizes the axillary artery and vein to fashion a synthetic loop graft.
Method
A synthetic arteriovenous loop graft is formed using the axillary artery and vein under general anesthesia following pre-operative contrast venograms.
Discussion
This method allows the use of the upper arm vessels, thereby preserving vessels in the legs; it also facilitates immediate access for dialysis.
Conclusion
The axillary-axillary loop graft is a valuable salvage option in patients with complex vascular access.
RooijensP.P., BurgsmanJ.P., YoT.I.. Autogenous radial-cephalic or prosthetic brachial-antecubital forearm loop AVF in patients with compromised vessels? A randomized, multicenter study of the patency of primary hemodialysis access.J Vasc Surg2005; 42: 481–6.
2.
HuberT.S., CarterJ.W., CarterR.L., SeegerJ.M.Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review.J Vasc Surg2003; 38: 1005–11.
3.
BagulA., KaushikM., KayM.D., NicholsonM.L.An alternative vascular access technique for haemodialysis; the loop mid-thigh graft.Ann R Coll Surg Engl2006. 88: 500–1.
