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

Maintaining a good quality vascular access in the long term can become particularly challenging especially in patients that are on dialysis for many years and present with exhausted venous capital and chronic access related complications. We present a 60-year-old female patient with multiple bilateral previous failed accesses, a previous distal revascularization interval ligation (DRIL) for hemodialysis access induced distal ischemia (HAIDI). Her chronically (more than a month) occluded arteriovenous fistula AVF was used to establish outflow and create a functioning forearm arteriovenous graft (AVG).

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Brachio-azygos transthoracic arteriovenous grafts for hemodialysis patients with bilateral central venous obstruction: A small case series

The Journal of Vascular Access ◽

10.1177/11297298211058580 ◽

2021 ◽

pp. 112972982110585

Author(s):

Dan Song ◽

Young Woo Park

Keyword(s):

Lower Extremity ◽

Vascular Access ◽

Median Sternotomy ◽

Case Series ◽

Hemodialysis Patients ◽

Arteriovenous Graft ◽

Venous Obstruction ◽

Central Venous ◽

Arteriovenous Grafts ◽

Central Venous Obstruction

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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Kidney allograft dysfunction due to ipsilateral thigh arteriovenous graft

The Journal of Vascular Access ◽

10.1177/1129729819877320 ◽

2019 ◽

Vol 21 (5) ◽

pp. 783-784

Author(s):

Nikhil Agrawal ◽

Neetika Garg ◽

Sreedhar Adapa ◽

Francesca Cardarelli

Keyword(s):

Transplant Recipient ◽

Lower Extremity ◽

Upper Extremity ◽

Kidney Transplant ◽

Dialysis Access ◽

Arteriovenous Graft ◽

Kidney Allograft ◽

Allograft Dysfunction

Arteriovenous graft in the thigh is used not infrequently for hemodialysis. Outcomes with this lower extremity dialysis access are generally comparable to upper extremity access and superior to long-term catheter use. However, it could have significant implications in a patient getting a kidney transplant. Here we describe a case of thigh arteriovenous graft causing kidney allograft dysfunction in a new transplant recipient, and this resolved with graft ligation.

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The use of a tunneled permanent catheter as temporary vascular access in arteriovenous graft patients for long-term patency

Renal Replacement Therapy ◽

10.1186/s41100-019-0235-6 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Masatoshi Matsunami ◽

Yuki Nakamura ◽

Kiho Tanaka ◽

Yoshifumi Ubara ◽

Yasuo Ishii

Keyword(s):

Vascular Access ◽

Arteriovenous Graft

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Cannulation practices at haemodialysis initiation via an arteriovenous fistula or arteriovenous graft

The Journal of Vascular Access ◽

10.1177/1129729819869093 ◽

2019 ◽

Vol 21 (5) ◽

pp. 573-581

Author(s):

Kathleen Hill ◽

Rebecca Sharp ◽

Jessie Childs ◽

Adrian Esterman ◽

Richard Le Leu ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Clinical Decision Making ◽

Central Venous Access ◽

Duplex Ultrasound ◽

Clinical Decision ◽

Venous Access ◽

Time Frame ◽

Arteriovenous Graft

Introduction: A functioning long-term vascular access is required for haemodialysis therapy; however, establishing this can be challenging in the setting of advanced age and vessels damaged by diabetes. Complications include the inability to insert two needles for the treatment resulting in miscannulation trauma and in some cases insertion of a temporary central venous access device. The broad objective of this review is to define the evidence base regarding cannulation practices in the initiation of haemodialysis via an arteriovenous fistula or an arteriovenous graft. Methods: This review uses the framework recommended by the Joanna Briggs Institute and the process by which papers were included or excluded followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses group approach. A total of 20 primary research studies met the inclusion criteria. Results: Cannulation in the 10- to 15-week period rather than delaying past this time frame is associated with the best outcomes. New vascular access given time to mature through single-needle haemodialysis treatments may improve long-term patency. Duplex ultrasound mapping prior to initiation of cannulation supports the clinical decision-making process on timing of and selection of cannulation sites. Conclusion: Cannulation trauma at the initiation of haemodialysis could potentially be reduced with a strategy of incremental haemodialysis using single-needle treatment supported with duplex ultrasonography assessment to ‘map’ the vascular access as a guide for clinicians prior to cannulation initiation.

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Good Long Term Patency Rates Associated with an Alternative Technique in Vascular Access Surgery – The Adductor Loop Arteriovenous Graft

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2010.09.019 ◽

2011 ◽

Vol 41 (4) ◽

pp. 566-569 ◽

Cited By ~ 10

Author(s):

J.A. Gilbert ◽

P.J. Gibbs

Keyword(s):

Vascular Access ◽

Arteriovenous Graft ◽

Alternative Technique ◽

Vascular Access Surgery ◽

Access Surgery

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Increasing Dialysis Access Options in Lower Extremity: Retroperitoneal Approach for External Iliac Artery-Vein Arteriovenous Graft

The Journal of Vascular Access ◽

10.5301/jva.2011.6452 ◽

2011 ◽

Vol 12 (4) ◽

pp. 365-368 ◽

Cited By ~ 4

Author(s):

Benjamin D. Colvard ◽

Javier E. Anaya-Ayala ◽

Deborah Palacios-Reyes ◽

Zulfiqar F. Cheema ◽

Christopher J. Smolock ◽

...

Keyword(s):

Lower Extremity ◽

Iliac Artery ◽

External Iliac Artery ◽

Retroperitoneal Approach ◽

Dialysis Access ◽

Arteriovenous Graft

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Review for "Short‐ and long‐term reciprocal bone‐muscle relationships in the upper and lower extremity of Afro‐Caribbean men by DXA : a longitudinal analysis of the Tobago Bone Health Study"

10.1002/jbm4.10406/v1/review2 ◽

2020 ◽

Author(s):

Jad Sfeir

Keyword(s):

Lower Extremity ◽

Longitudinal Analysis ◽

Bone Health ◽

Health Study ◽

Short And Long Term

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Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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