Background: Increase the need for hemodialysis (HD) due to concomitant increase incidence of nephropathic disease in association with increase in patients' life expectancy in the last three decades, makes it necessary to establish secondary or tertiary dialysis access to overcome exhausted peripheral veins and central venous occlusion.
Purpose: Our case study reports mid-term (24 months follow-up) results with Infraclavicular arterio-arterial loop graft (IAALG) and evaluates their efficacy and safety in construction of vascular access for patients with end-stage renal disease (ESRD).
Methods: From December 2014 to December 2017, 45 patients with ESRD on chronic hemodialysis with exhausted all peripheral and central veins or were considered unsuitable for creation of arterio-venous fistula / graft (AVF, AVG) were underwent arterio-arterial chest wall prosthetic graft implantation for creation of hemodialysis vascular access.
Results: The primary patency rates were 100%, 97.7%, 93%, 77.5% and 73.7% at 6, 9, 12, 18, and 24 months, respectively. The secondary patency was 100%, 85.7%, and 66.6% at 6, 9, and 12 months, respectively, after
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successful thrombectomy in nine patients. There were 20 (44.4%) secondary variable procedures performed during follow-up period with no procedure related mortality or limb threatened conditions were documented in our study.
Conclusion: our case study reports reasonable mid-term patency and complications associated with this pattern of vascular access show that Infraclavicular arterio-arterial loop grafts are a valid alternative option for complex patients. We advocate the use of this technique in patients with exhausted all vascular access possibilities in both upper extremities with central venous obstruction. We also indicate it in case of patients with cardiac insufficiency that could not tolerate long-term hemodynamic effect of arterio-venous fistula / graft. |
