Axillary Artery to Right Atrium Bypass for Hemodialysis in a Patient with Difficult Vascular Access

Introduction: Central venous occlusive (CVO) disease involving the superior vena cava (SVC) and inferior vena cava (IVC) can occur frequently in patients with end-stage renal disease (ESRD) on chronic dialysis. Dialysis access is essential for the survival of these patients. Case description: We report a case of a chest wall graft creation using bovine carotid artery conduit in a patient who was experiencing life-threatening loss of dialysis access secondary to her SVC and IVC occlusion along with a hypercoagulable state. We did a subcutaneous anterior chest wall graft from the left axillary artery to the right atrium (RA) using a mini thoracotomy incision. Conclusions: ESRD patients with CVO pose a unique challenge. We believe our approach can provide an excellent option for dialysis access in patients with exhausted conventional access options.

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Endovascular management of thrombosed axillary artery to right atrium hemodialysis graft

Clinical Imaging ◽

10.1016/j.clinimag.2014.06.007 ◽

2014 ◽

Vol 38 (6) ◽

pp. 880-883 ◽

Cited By ~ 2

Author(s):

Nii-Kabu Kabutey ◽

Steve Deso ◽

Leslie Wong ◽

Michael D. Sgroi ◽

Ducksoo Kim

Keyword(s):

Right Atrium ◽

Axillary Artery ◽

Endovascular Management ◽

Hemodialysis Graft

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Axillary artery loop interposition graft (AALG) as unusual access for hemodialysis

International Surgery Journal ◽

10.18203/2349-2902.isj20175154 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3853

Author(s):

Abdelmieniem Fareed ◽

Nehad Zaid ◽

Yahia M. Alkhateep

Keyword(s):

Renal Disease ◽

Vascular Access ◽

End Stage Renal Disease ◽

Axillary Artery ◽

Severe Infection ◽

Cardiac Insufficiency ◽

Secondary Patency ◽

Efficient Alternative ◽

Stage Renal Disease ◽

End Stage

Background: Life expectancy of end stage renal disease patients continues to lengthen and with the limited durability of vascular accesses, repeat fistula construction at different levels of the upper limb is often necessary and leads ultimately to exhaustion of autogenous vascular access sites. Our experience with alternative vascular access procedures namely the arterio-arterial loop graft in the first part of axillary artery was presented in this study.Methods: From June 2013 to Aug 2017, arterio-arterial interposition loop graft procedures (AALG) for vascular access were performed in 15 patients with end-stage renal disease. Inclusion criteria were patients with unsuitable large deep veins or with cardiac insufficiency intolerable to high-flow arterio-venous fistula.Results: The achieved primary and secondary patency was 73.3 % and 86.6% at 1 year and 53.3 % and 66.7 % at 3 years. Severe infection in whole graft occurred in two patients (13.3%) after 11, 27 months. One patient died six months after operation due to unrelated cause. two patients had pseudoaneurysms after 20 and 28 months at sites of repetitive needle puncture and were treated successfully by segmental replacement.Conclusions: In selected cases and with proper indication the AALG can offer efficient alternative for vascular hemodialysis access and can improve the survival rate of such patients.

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Implantation of a hemodialysis catheter directly in the right atrium due to exhaustion of vascular access

Scripta Scientifica Medica ◽

10.14748/ssm.v52i3.6642 ◽

2020 ◽

Vol 52 (3) ◽

pp. 32

Author(s):

Pavlin Manoilov ◽

Plamen Panayotov ◽

Veselin Petrov ◽

Georgi Todorov ◽

Milen Slavov

Keyword(s):

Vascular Access ◽

Right Atrium ◽

Hemodialysis Catheter ◽

The Right

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Exhaustion of Vascular Endowment in Hemodialysis: Proposal for a Permanent Inlet Access

The International Journal of Artificial Organs ◽

10.1177/039139889802100405 ◽

1998 ◽

Vol 21 (4) ◽

pp. 201-204 ◽

Cited By ~ 1

Author(s):

G. Bellinghieri ◽

B. Ricciardi ◽

G. Costantino ◽

F. Torre ◽

D. Santoro ◽

...

Keyword(s):

Vascular Access ◽

Right Atrium ◽

Good Compliance ◽

Correct Sequence ◽

The Right ◽

Regular Hemodialysis ◽

Double Chamber

The subcutaneous reservoir is a new vascular access for patients on regular hemodialysis (HD). A double chamber in Titanium- Pirolytic Carbon with siliconic boreable superior caps is inserted in to a subcutaneous subclavian side, and always in subcutis connected to two siliconic catheters located in the right jugular resulting in the right atrium. The puncture of each chamber is performed with a special hemodialysis-cannula telescopically assembled on a “dilatation tube”, in which a stylet is inserted. In correct sequence, the cutaneous planes and the caps are bored, dilated, and finally the HD cannula after sliding over the previous structures is positioned in the inner chamber, closing the HD circuit. In our study two patients were implanted, with a survival of 24 months, good compliance, no cardiovascular impairments and lack of catheteral pathology.

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

Interventional Cardiology Review ◽

10.15420/icr.2019.22 ◽

2020 ◽

Vol 15 ◽

Cited By ~ 1

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.

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Brachial and axillary artery vascular access for endovascular interventions

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.09.052 ◽

2021 ◽

Author(s):

Charlotte M Lentz ◽

Donika Zogaj ◽

Hanna K Wessel ◽

Clark J Zeebregts ◽

Reinoud PH Bokkers ◽

...

Keyword(s):

Vascular Access ◽

Axillary Artery ◽

Endovascular Interventions

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PS78. Prevention of Vascular Access Hand Ischemia Using the Axillary Artery as Inflow

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.03.132 ◽

2012 ◽

Vol 55 (6) ◽

pp. 47S-48S

Author(s):

Robert E. Brown ◽

William C. Jennings ◽

John Blebea ◽

Kevin Taubman ◽

Ryan Messiner

Keyword(s):

Vascular Access ◽

Axillary Artery ◽

Hand Ischemia

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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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