Axillofemoral Fistula for Hemodialysis Access

Alternative Venous Outflow by Brachial to Jugular Vein Vascular Access for Hemodialysis in the Exhausted Upper Extremities

“…Some concerns have been raised about creating vascular access in patients with vascular exhausted upper arms. As a solution, complex grafts, including the necklace fistula (8), axillary-axillary interarterial chest loop graft (9, 10), superficialization of the radial artery (11), axillary artery to right atrium (12), femororenal (13), axillary artery to internal mammary vein (14), axillofemoral (15), axilloiliac conduit (16), saphenous loop to a femoral artery AV fistula (17) and the axillorenal AV grafts have been used (18). Use of a Hemodialysis Reliable Outflow (HeRO) device may be an alternative in these patients (19).…”

Unusual Sites for Hemodialysis Vascular Access Construction and Catheter Placement: A Review

“…Axillary-femoral or axillary-popliteal arteriovenous grafts: These configurations are reserved for patients with completely occluded or severely stenosed upper extremity vessels and central venous system including the superior vena cava in which endovascular or surgical revascularization were either unsuccessful or impossible (34) (Fig. 4).…”

“…Therefore care needs to be taken to avoid periods of low blood pressure. Other noted complications include prosthesis kinking and high infection rate in the outflow anastomosis in the inguinal region (34).…”

“…Schematic diagram illustrating an axillary-femoral graft. Reproduced with permission from (34): Utikal P, Bachleda P, Koecher M, Drac P, Cerna M. Axillofemoral fistula for hemodialysis access. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub.…”