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

2005 ◽  
Vol 6 (4) ◽  
pp. 192-195 ◽  
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.

scholarly journals TCT-368 Axillary Artery Access in the Setting of Cardiogenic Shock and Severe Peripheral Arterial Disease

2019 ◽  
Vol 74 (13) ◽  
pp. B365
Author(s):  
Marvin Kajy ◽  
Amir Laktineh ◽  
M. Chadi Alraies ◽  
Nimrod Blank ◽  
Theodore Schreiber ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Cardiogenic Shock ◽  
Axillary Artery ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals Emerging Role of Large-bore Percutaneous Axillary Vascular Access: a Step-by-step Guide

2020 ◽  
Vol 15 ◽  
Author(s):  
Kathryn Dawson ◽  
Tara L Jones ◽  
Kathleen E Kearney ◽  
James M McCabe
Keyword(s):  
Vascular Access ◽  
Mechanical Circulatory Support ◽  
Axillary Artery ◽  
Bed Rest ◽  
Arterial Disease ◽  
Circulatory Support ◽  
Femoral Access ◽  
Management Of Complications ◽  
Peripheral Arterial ◽  
Alternative Sites

Advances in transcatheter structural heart interventions and temporary mechanical circulatory support have led to increased demand for alternative sites for large-bore vascular access. Percutaneous axillary artery access is an appealing alternative to femoral access in patients with peripheral arterial disease, obesity or for prolonged haemodynamic support where patient mobilisation may be valuable. In particular, axillary access for mechanical circulatory support allows for increased mobility while using the device, facilitating physical therapy and reducing morbidity associated with prolonged bed rest. This article outlines the basic approach to percutaneous axillary vascular access, including patient selection and procedure planning, anatomic axillary artery landmarks, access techniques, sheath removal and management of complications.

P1346PLANNING VASCULAR ACCESS CREATION FOR HEMODIALYSIS: IS THERE A ROLE FOR THE NEPHROLOGIST? A SINGLE-CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Cunha Rodrigues ◽  
Luísa Lemos Costa ◽  
André Ferreira ◽  
Carolina Reis Ferreira ◽  
Andreia Silva ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Peripheral Arterial Disease ◽  
Vascular Access ◽  
Arterial Disease ◽  
First Line ◽  
Vascular Surgeon ◽  
Ckd Stage ◽  
Vascular Mapping ◽  
History Of ◽  
Peripheral Arterial

Abstract Background and Aims Vascular access planning is a crucial step in the path to dialysis treatment. Although the vascular surgeon role is of undeniable importance on vascular access creation, the nephrologist’s view may be an added advantage on vascular access planning. Method A retrospective observational study of the vascular access appointments carried out at the Centro Hospitalar de Tondela-Viseu’s nephrology department between 1/1/2017 and 13/12/2019 was performed. Of the 173 consultations reviewed, 71 patients were referred to preoperative vascular mapping, which were selected. In those selected, 38 had a vascular access built. A descriptive and statistical analysis of the population and proposed vs constructed access was performed. Results Of those patients referred to the vascular access appointment for vessel mapping, the median age was 70 years, the majority were men (59.2%), most of them had Chronic Kidney Disease (CKD) stage 5 (57.7%) and most frequently had Diabetic Nephropathy (38.6%) or Chronic Glomerulonephritis (14.9%) as the cause of kidney disease. The majority were Diabetic (62%), Hypertensive (91.5%), Obese (63.4%) and had a history of stroke, coronary or peripheral arterial disease (63.4%). The vascular mapping was performed for creation of first access in 64.8% of the patients and the nephrologist most commonly proposed a radio-cephalic fistula (63.6%) as first line access creation, followed by brachio-cephalic (30.3%) and brachio-basilic (6%) fistulas. An arteriovenous graft was suggested in only 1 case and 4 patients were not referred to the vascular surgeon as they had no vascular patrimony to autologous vascular access creation. Regarding those patients who had already a vascular access at the time of this study (n=36), 58.33% coincided with the first line access suggested by the nephrologist. We found that the nephrologist most frequently proposed a brachio-basilic fistula in older patients (median age 77.5), while younger patients had proposed other fistulas (median age 77.5 years, p=0.031). Those patients without history of stroke, coronary or peripheral arterial disease had 4.57 times more odds of being proposed to a radio-cephalic fistula (p=0.007) and those with history of atherosclerotic events had 4.36 times more odds of being proposed for a brachio-cephalic fistula (p=0.003). Patients with more vascular calcification on the vessel mapping appointment had 7 times more odds of not being proposed for a distal fistula (p=0.000) and had instead 5.56 times more odds of being proposed to a brachio-cephalic fistula (p=0.003). Gender, etiology of CKD, smoking, diabetes, hypertension, heart failure and obesity were not significantly associated with vascular access proposed by the nephrologist. Conclusion In light of the results of this study, we conclude that there is an important place for ultrasound preoperative mapping by the nephrologist on planning the vascular access for haemodialysis.

Peripheral Arterial Disease in Hemodialysis Access

2014 ◽  
pp. 181-196
Author(s):  
Kanwar Singh ◽  
Matthew E. Anderson ◽  
Anil Kumar Pillai ◽  
Sanjeeva P. Kalva
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Hemodialysis Access ◽  
Peripheral Arterial
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