Mid-thigh Arteriovenous Graft in Lower Extremity Vascular Access Construction for Hemodialysis Patients

Background: It is difficult to find a reliable outflow vein for vascular access in hemodialysis patients with bilateral central venous obstruction. The lower extremity veins are currently used as the most common alternative veins to make a new vascular access. However, in patients not amenable to make lower extremity access, intrathoracic vein should be considered as an outflow vein, but there are limitations in its use due to postoperative complications. Methods: We introduce a series of cases that underwent arteriovenous graft operation using an intrathoracic vein, the azygos arch, as an outflow vein. Brachio-azygos transthoracic arteriovenous graft is a surgical procedure that anastomoses the azygos arch and the brachial artery with 7 mm ringed polytetrafluoroethylene graft via lateral thoracotomy without median sternotomy. Results: The chest tubes of the patients were removed on the third postoperative day and they discharged within a week. About 1 month later, hemodialysis was initiated through the BATAVG, and it has been used without access dysfunction. Conclusion: Brachio-azygos transthoracic arteriovenous grafts were performed using the azygos arches without major complications. The azygos arch can be a good alternative outflow vein to make a new vascular access for hemodialysis patients with bilateral central venous obstruction.

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Retroperitoneal Approach for Lower Extremity Arteriovenous Graft as Long-Term Vascular Access in a Complex Case

Case Reports in Nephrology and Urology ◽

10.1159/000341105 ◽

2012 ◽

Vol 2 (2) ◽

pp. 83-86

Author(s):

Mingli Zhu ◽

Yaxue Shi ◽

Jiejun Cheng ◽

Huihua Pang ◽

Leyi Gu ◽

...

Keyword(s):

Lower Extremity ◽

Vascular Access ◽

Retroperitoneal Approach ◽

Complex Case ◽

Arteriovenous Graft

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Mean Platelet Volume Predicts Vascular Access Events in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm8050608 ◽

2019 ◽

Vol 8 (5) ◽

pp. 608

Author(s):

Guillaume Lano ◽

Marion Sallée ◽

Marion Pelletier ◽

Stanislas Bataille ◽

Megan Fraisse ◽

...

Keyword(s):

Vascular Access ◽

Mean Platelet Volume ◽

Primary Outcome ◽

Biological Marker ◽

Predictive Marker ◽

Hemodialysis Patients ◽

Arteriovenous Graft ◽

Platelet Volume ◽

Acute Thrombosis ◽

Independent Association

Arteriovenous fistula (AVF) and arteriovenous graft (AVG) is the vascular access (VA) of 78% of hemodialysis patients (HD) in France. VA dysfunction corresponding to either stenosis requiring angioplasty or acute thrombosis is responsible for 30% of hospitalizations. Mean platelet volume (MPV) is a biological marker of cardiovascular events. We studied MPV in a cohort of HD patients as a predictive marker of VA dysfunction. We conducted a prospective monocentric cohort study that included patients with AVF or AVG on chronic HD (n = 153). The primary outcome was the incidence of VA dysfunction regarding MPV value. The median MPV was 10.8 fL (7.8–13.5), and four groups were designed according to MPV quartiles. Fifty-four patients experienced the first event of VA dysfunction. The incidence of VA dysfunction was higher in patients with the highest MPV: 59% (23 events), 34% (14 events), 27% (11 events), and 18% (6 events), respectively, for the fourth, third, second, and first quartiles (p = 0.001). Multivariate analysis confirmed an independent association between MPV and VA dysfunction—OR 1.52 (1.13–2.07), p < 0.001. VA dysfunction is predicted by MPV level. Patients with the highest MPV have the highest risk of VA events.

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Role of Color Doppler Ultrasonography in Assessment of Vascular Access Surveillance in Hemodialysis Patients.

Case Medical Research ◽

10.31525/ct1-nct04196478 ◽

2019 ◽

Author(s):

Keyword(s):

Vascular Access ◽

Doppler Ultrasonography ◽

Color Doppler ◽

Hemodialysis Patients ◽

Color Doppler Ultrasonography

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Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

The Journal of Vascular Access ◽

10.1177/1129729820965064 ◽

2021 ◽

pp. 112972982096506

Author(s):

Eva Chytilova ◽

Tamara Jemcov ◽

Jan Malik ◽

Jernej Pajek ◽

Branko Fila ◽

...

Keyword(s):

Vascular Access ◽

Doppler Ultrasonography ◽

Arteriovenous Graft ◽

Central Venous ◽

Preoperative Mapping ◽

High Incidence ◽

Arteriovenous Access ◽

Ultrasound Parameters ◽

Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

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