Axillary-axillary interarterial chest loop conduit as an alternative for chronic hemodialysis access

OBJECTIVE: After exhaustion of all conventional arteriovenous (AV) access options, an alternative approach is an arterioarterial conduit. The purpose of this study was to examine the utility of an axillary-axillary (AA) interarterial (IA) access in this subset of patients. METHODS: A retrospective review was performed of all patients who underwent placement of an AA IA access. Patients were observed for functional aspects and complications. Outcomes were determined according to the Society for Vascular Surgery/American Association for Vascular Surgery standards for reports for dealing with AV accesses. RESULTS: Twenty patients (median age, 59 years; range, 41-82 years) underwent AA IA access placement under general anesthesia between May 2001 and December 2004. Exhausted upper extremity AV access options were found in 14 patients (70%), with central vein occlusion in 5 patients (25%), and 12 patients (60%) had ischemia from steal syndrome. High-output cardiac failure was present in one patient. Median follow-up was 7.4 months (range, 0.5-45.3 months). The 30-day perioperative mortality rate was 5%. There was one (5%) early access thrombosis that resulted in moderate ischemia. Late access thrombosis occurred in three patients (15%), and all cases were asymptomatic. Early postoperative bleeding necessitated surgical intervention in four patients (20%). Late graft infection (n = 1; 5%) occurred after repeated thrombectomy. The primary and secondary patency rate was 90% and 93%, respectively, at 6 months. CONCLUSIONS: This short-term initial study showed that the AA IA loop access could be implanted with acceptable perioperative morbidity and with an excellent secondary patency rate. Further follow-up is necessary to determine the long-term complication rate and to allow more reasonable comparison with other methods of access.