PTFE graft arteriovenous fistulae for hemodialysis access

The use of expanded PTFE graft arteriovenous fistulae for hemodialysis access is becoming increasingly popular. Its low infection rate, low thrombogenicity, low body reactivity, and longevity make it an ideal vascular substitute. From May 1976 to June 2, 1978 we have placed 102 grafts in 89 patients, many of whom represent management problems of other access means. Major complications are pseudointimal proliferation at the venous anastomosis, pseudoaneurysm formation, and thrombosis, usually associated with low blood volume. These problems are, however, readily rectifiable. Other types of grafts, according to the literature, have not been successful for hemodialysis access.     

Femororenal arteriovenous graft: a viable option for hemodialysis access

There has been a significant increase in the number of patients with end-stage renal disease. The limited number of kidney transplants necessitates that most patients become dependent upon chronic dialysis. Due to the numerous complications associated with temporary access catheters, permanent arteriovenous access is more beneficial for long-term vascular access. However, with the restricted availability of sites for permanent vascular access, it is important to have a variety of possibilities. In this case report, we present an alternative choice for an arteriovenous graft, left common femoral artery to left renal vein, in a patient with limited vascular access options.     

Vascular access for chronic hemodialysis using modified bovine arterial graft arteriovenous fistula

Modified bovine arterial graft arteriovenous fistulas were used for access to the circulation for hemodialysis in thirty-six patients whose forearm vessels were unsuitable for Brescia-Cimino fistulas. Twenty-seven of thirty-one thigh fistulas and three of five forearm fistulas are still functioning well. Most of the complications were minor and may be preventable. Thigh heterografts provided excellent blood flow for dialysis and have been the most successful alternative for patients who have repeated shunt or fistula failures.     

Bovine graft arteriovenous fistula for hemodialysis

Repeated failure of conventional methods for hemodialysis has prompted the use of bovine arterial grafts as conduits in arteriovenous fistulas. Complications encountered in the use of the graft have been infrequent and have been attributed to technical difficulties that arose in four of the first five patients operated on. After revision of the operative technic no additional complications have been seen in the remaining twenty patients. These results are encouraging and the procedure warrants further investigation. The use of the modified bovine carotid artery graft in the construction of subcutaneous arteriovenous fistulas for chronic hemodialysis may be the procedure of choice.     

The reverse upper arm curved graft with ringed PTFE graft as an alternative vascular access procedure for hemodialysis

AIM: Prosthetic arteriovenous accesses are the last resort after efforts to place autogenous accesses are exhausted. During reimplantation of the graft, it is sometimes not convenient to dissect out the vessels to be grafted, especially around the venous anastomotic site and under local anesthesia. METHODS: We describe a technique using the ringed PTFE graft for the construction of a reverse upper arm curved graft in 14 patients who had received upper arm grafts previously. RESULTS: The mean operative time was 61+/-13 minutes, and the follow-up interval extended to 20 months. No infections, pseudoaneurysm formations, or steal syndrome occurred during the follow-up period. The primary patency rate was calculated by Kaplan-Meier analysis, and the primary patency from graft insertion to clotting in the reverse graft was 91% at 3 months, 83% at 6 months, 66% at 9 months, and 57% at 12 months. CONCLUSION: These results suggest that using the reverse upper arm curved graft during the reimplantation procedure was an alternative prosthetic arteriovenous access with the advantage of less tissue dissection, shorter operation time, and favorable patency rate.     

A polyurethane vascular access graft and a hybrid polytetrafluoroethylene graft as an arteriovenous fistula for hemodialysis: comparison with an expanded polytetrafluoroethylene graft

AIM: We evaluated a polyurethane vascular access graft (TVAG), a hybrid polytetrafluoroethylene graft (hPTFEG), and an expanded polytetrafluoroethylene graft (ePTFEG) for postoperative complications and graft patency in their use as prosthetic devices of vascular access for hemodialysis. METHODS: Between August 1993 and October 2001, we treated 200 patients in whom A-V fistulas were placed by the same surgeon. These were divided into the following four groups according to the type of blood access: 27 cases of ePTFEG, 23 cases of TVAG, 22 cases of hPTFEG, and 128 cases of an autogenous A-V fistula. We calculated the cumulative patency rates by the Kaplan-Meier method, including primary (problem-free) and secondary (revised or functional) patency rates. RESULTS: The hPTFEG group experienced few thromboses. The absence of perigraft edema in the TVAG group permitted the early use of the TVAG within a few postoperative days for hemodialysis. Among the three graft groups, the primary patency was the best in the hPTFEG group (94.7% at 1 year and 86.1% at 2 years), with a significant difference versus the ePTFEG group. In regard to secondary patency, hPTFEG had an excellent patency of 100% at 1 year and 90.9% at 2 years, and TVAG had a comparable patency with that of ePTFEG. CONCLUSION: The hPTFEG was considered superior to ePTFEG in terms of being complication-free and had the excellent 2 year secondary patency of 90.9%. TVAG, with a patency equal to that of ePTFEG, could be used immediately after implantation due to the absence of limb edema.     

Dacron velour arteriovenous fistula for hemodialysis access

Dacron velour arteriovenous fistulas were created in the necks of 12 dogs. Sham dialysis was performed three times per week for one month in six animals, and for six months in an additional six animals. One prosthesis became infected, and perigraft bleeding occurred twice. There were no false aneurysms, and all prostheses remained patent. Dacron velour appears to be a satisfactory prosthetic material for use as an arteriovenous fistula for chronic hemodialysis access. The enhanced fibrous tissue adherence of Dacron velour may account for the few complications encountered.     

Bovine graft as arteriovenous fistula for hemodialysis

We used the bovine carotid artery (BCA) as arteriovenous shunt for hemodialysis in 11 patients since December 1975. We discuss our results. For implantations we used two methods: straight and loop grafts. The BCA have many advantages as: good access for punction, anticoagulation not permanently necessary, volume of shunt more than 250 ml/min; the disadvantages are: increased tendence to infection and thrombosis. Thrombosis in BCA can be easier removed than in other grafts. Reduction of the complications incidence is possible with an accurate technique. We think that the BCA is very useful when Cimino-Brescia fistula has failed or is unavailable; we prefer BCA to a saphenous arteriovenous graft in these situations.     

Axillary to common iliac arteriovenous graft for hemodialysis access: Case report and review of 'exotic' axillary-based grafts

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.     

前臂远端贵要静脉转位建立自体血管内瘘手术

目的 探讨前臂远端贵要静脉转位建立自体血管内瘘的方法.方法 自2007年12月至2009年12月我们对26例维持性血液透析患者进行前臂远端贵要静脉转位建立自体血管内瘘手术治疗.26例中有17例为原桡动脉-头静脉内瘘因并发症失去功能,9例初次行血管内瘘手术.手术方式采用贵要静脉转位与肱动脉端侧吻合;贵要静脉转位与桡-动脉端端吻合;贵要动脉与尺动脉端侧或端端吻合,吻合口直径为5.0～8.0 mm.结果 26例患者中有1例因术后血肿压迫闭塞,2例因术后内瘘成熟不良,其余手术患者一次取得成功,术后血流量达200～350 ml/min.对患者的心功能未造成不良影响,也未出现严重并发症.结论 只要适应证选择合适,前臂远端贵要静脉转位建立自体血管内瘘手术,是尽量利用自身血管条件,建立内瘘的一种行之有效的方法.     

The mid-thigh loop arteriovenous graft: patient selection, technique, and results

As patient longevity on hemodialysis has increased, surgeons are increasingly challenged to provide vascular access to patients who have exhausted options for access in the upper extremity. A common operation performed on these patients has been the loop thigh arteriovenous (AV) graft based off the common femoral vessels. However, there are several disadvantages of placing prosthetic grafts in proximity to the groin. Our group has modified the thigh loop AV graft procedure by moving the anastomoses to the mid-superficial femoral artery and vein. The advantage of this location is that it preserves the proximal femoral vessels for graft revision and avoids the node-bearing tissue and overhanging panniculus of the groin. The purpose of this study was to review our technique, patient selection, and experience with the mid-thigh loop AV graft procedure. Between 2001 and 2003, 46 mid-thigh loop AV grafts were placed in 38 patients. Patient hospital, office, and dialysis clinic records were reviewed. The primary and secondary patency for AV grafts in this study by life-table was 40 per cent and 68 per cent at 1 year and 18 per cent and 43 per cent at 2 years. There were 10 infections (21%) requiring graft removal. Four patients underwent subsequent placement of a proximal loop thigh AV graft after mid-thigh graft failure. Patient survival was 86 per cent at 1 year and 82 per cent at 2 years. There were no patient deaths related to thigh graft placement. Our results with the mid-thigh loop AV graft compare favorably with published results for thigh loop AV grafts. The procedure preserves the proximal vasculature, permitting graft revision or subsequent proximal graft placement, and may be associated with fewer infectious complications. The mid-thigh loop AV graft procedure should be considered before placement of a thigh loop AV graft based off the common femoral artery and vein.     

Axillorenal arteriovenous graft: a new approach for dialysis access

As the population requiring hemodialysis grows, it becomes increasingly common to encounter patients with limited options for vascular access. Because inability to secure vascular access is a life-threatening problem, it is important to consider all possible options in each patient. We report a new arteriovenous grafting procedure in which the left renal vein is used for outflow in a patient with multiple venous occlusions. Patency of the graft continues 18 months after placement. This graft carries acceptable morbidity, and can be revised. Consideration of this graft is appropriate in selected patients.