Discovery of a large axillary artery vascular malformation during the evaluation of a patient with hemodialysis access‐induced distal ischemia: Implications on pathophysiology and management

A patient with occlusion of multiple central veins from both dialysis and nondialysis catheters required permanent access for hemodialysis. Magnetic resonance imaging showed a patent left innominate vein. He underwent creation of a left axillary artery to internal mammary vein transposition fistula using the basilic vein from his right arm. The fistula has required one revision for outflow stenosis and one for aneurysmal degeneration. It continues to function well 3 years after placement. The internal mammary vein is an option for outflow when permanent hemodialysis access has failed in the presence of a patent innominate vein with occluded or severely stenotic ipsilateral subclavian and jugular veins.

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Axillary to Common Iliac Arteriovenous Graft for Hemodialysis Access: Case Report and Review of “Exotic” Axillary-Based Grafts

The Journal of Vascular Access ◽

10.1177/112972980500600407 ◽

2005 ◽

Vol 6 (4) ◽

pp. 192-195 ◽

Cited By ~ 9

Author(s):

D.C. Evans ◽

E.C. Upton ◽

J.H. Lawson

Keyword(s):

Peripheral Arterial Disease ◽

Vascular Access ◽

Axillary Artery ◽

Arterial Disease ◽

Iliac Vein ◽

Common Iliac Vein ◽

Ptfe Graft ◽

Arteriovenous Graft ◽

Hemodialysis Access ◽

Peripheral Arterial

A 58-year-old Caucasian male with end-stage renal disease and peripheral arterial disease was referred to us for management of his complex vascular access. His vascular access history included a left wrist primary fistula, a left upper arm access graft, a left leg loop graft, and multiple PermCaths in his jugular veins with recurrent infections. Magnetic resonance venography (MRV) of his chest revealed extensive bilateral venous occlusions due to numerous past hemodialysis access catheters. The patient was scheduled for right lower extremity arteriovenous graft placement, but intraoperatively was found to have severe peripheral arterial disease and a thromboendarterectomy was performed instead. Lower body venous imaging demonstrated patent iliac veins. Based on these anatomic considerations a right axillary artery to right common iliac vein polytetrafluoroethylene (PTFE) graft was placed. The graft required revision twice – once for graft ultrafiltration at the arterial end of the graft and once for needle stick infection – but continues to serve as sufficient access after 15 months. Grafts based off the axillary artery have become increasingly popular in recent years and several venous outflow options have been considered, each with distinct advantages. The common iliac vein offers a central location with high flow rate and low probability of infection. Axillary artery to iliac vein arteriovenous grafting may have a place in the vascular surgeon's armamentarium for complex vascular access cases.

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Endovascular Repair for Ruptured Axillary Artery Aneurysm Proximal to Hemodialysis Access

Vascular and Endovascular Surgery ◽

10.1177/1538574419844072 ◽

2019 ◽

Vol 53 (5) ◽

pp. 429-432

Author(s):

Tomoya Takigawa ◽

Shigehiko Tokunaga ◽

Hironori Baba ◽

Manabu Hisahara ◽

Yoshie Ochiai ◽

...

Keyword(s):

Endovascular Repair ◽

Axillary Artery ◽

Artery Aneurysm ◽

Hemodialysis Access

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Comparison of axillary-atrial and axillary-iliac arteriovenous grafts for hemodialysis access creation

The Journal of Vascular Access ◽

10.1177/1129729819851919 ◽

2019 ◽

Vol 21 (1) ◽

pp. 55-59

Author(s):

Gabriel Lopez-Pena ◽

Javier E Anaya-Ayala ◽

Ramon Garcia-Alva ◽

Lizeth Luna ◽

Rene Lizola ◽

...

Keyword(s):

Axillary Artery ◽

Infectious Complications ◽

Primary Patency ◽

Secondary Patency ◽

Arteriovenous Graft ◽

Hemodialysis Access ◽

Endovascular Recanalization ◽

Arteriovenous Grafts ◽

The Right ◽

Stage Renal Disease

Objective: The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. Methods: This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients’ demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. Results: Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). Conclusion: Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.

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Axillary Artery to Right Atrium Shunt for Hemodialysis Access in a Patient with Advanced Central Vein Thrombosis: A Case Report

Annals of Vascular Surgery ◽

10.1007/s10016-006-9032-0 ◽

2006 ◽

Vol 20 (3) ◽

pp. 418-421 ◽

Cited By ~ 11

Author(s):

David Kopriva ◽

Ahmad Moustapha

Keyword(s):

Case Report ◽

Right Atrium ◽

Axillary Artery ◽

Central Vein ◽

Hemodialysis Access ◽

Vein Thrombosis

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Histological verification of non-specific aorta-arteritis (Takayasu's arteritis) using percutaneous transluminal atherectomy

VASA ◽

10.1024/0301-1526.33.4.247 ◽

2004 ◽

Vol 33 (4) ◽

pp. 247-251 ◽

Cited By ~ 6

Author(s):

Zeller ◽

Koch ◽

Frank ◽

Bürgelin ◽

Schwarzwälder ◽

...

Keyword(s):

Clinical Diagnosis ◽

Axillary Artery ◽

Takayasu’S Arteritis ◽

Giant Cells ◽

Interventional Therapy ◽

Takayasu's Arteritis ◽

New Device ◽

First Case ◽

Anti Inflammatory ◽

Percutaneous Transluminal

Diagnosis of non-specific aorto-arteritis (NSAA, Takaysu's arteritis) is typically based on clinical and investigational parameters. We report here about two patients with clinically suspected diagnosis of a Takayasu's arteritis already under anti-inflammatory therapy in whom percutaneous transluminal atherectomy of subclavian and axillary artery stenoses was performed to relief the patients from symptoms – intermittent dyspraxia of the arms – and to verify the clinical diagnosis by histology. In the first case aorto-arteritis could be histologically confirmed through the analysis of plaque material including media structures excised from the subclavian and axillary arteries using a new device for atherectomy. The biopsy showed diffuse inflammation and granulomatous lesions with giant cells typically for Takayasu's disease. In the second patient, biopsy showed no acute or chronic inflammatory signs but only atherosclerotic lesions. Percutaneous transluminal atherectomy is therefore not only an interventional but also a diagnostic tool and should be used in every case of interventional therapy of suspected aorto-arteritis to make the clinical diagnosis and as a major consequence the initiation of an aggressive anti-inflammatory medical therapy more reliable.

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